340B Drug Pricing Program Database
WAGNER'S CLIFFORD PHARMACY
FP188225 NEPA COMMUNITY HEALTHCARE - information as of 5/2/2025 12:01:34 AM
Covered Entity Details
Entity Name
NEPA COMMUNITY HEALTHCARE
Subdivision Name
HALLSTEAD FP CLINIC
Type
Family Planning (Title X only)
340B ID
FP188225
Entity Address
25066 STATE ROUTE 11
HALLSTEAD, PA 18822
Grant Number
FPHPA036053
Participating Start Date
1/1/1998
Last Recertification Date
5/12/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
WAGNER'S CLIFFORD PHARMACY
Pharmacy Address
1638 STATE ROUTE 106
PO BOX 189
CLIFFORD, PA 18413
Pharmacy Comments
Contract Details
Approval Date
8/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary W. Wetherall, CEO
(570) 278-5161
Contract Pharmacy Representative
Endless Mountains Pharmacy
William Wagner, President
(570) 222-7500
Signed By Date
8/20/2020
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