Contract Pharmacy Details

PHYSICIANS RX PHARMACY OF CLINTON, INC.
FQHCLA363 Sharon Lee Family Health Care, Inc.

Covered Entity Details

Entity Name

Sharon Lee Family Health Care, Inc.

Subdivision Name

Sharon Lee Family Health Care Rosedale

Type

Health Center Program Look-Alike

340B ID

FQHCLA363

Entity Address

340 Southwest Boulevard
Kansas city, KS 66103-2150

Grant Number

LALCS31530

Participating Start Date

4/1/2018

Last Recertification Date

2/2/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

PHYSICIANS RX PHARMACY OF CLINTON, INC.

Pharmacy Address

PHYSICIANS RX PHARMACY CLINTON
9131 PISCATAWAY ROAD
SUITE 670
CLINTON, MD 20735

Pharmacy Comments

Contract Details

Approval Date

5/10/2018

Contract Begin Date

5/11/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/7/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Sharon D Lee, President
(913) 362-0220

Contract Pharmacy Representative

Physicians Rx Pharmacy of Clinton
Chris Wakefield, Manager
(412) 357-5163

Signed By Date

5/10/2018

340B Drug Pricing Program Database