Contract Pharmacy Details

HAGUE PHARMACY
CH034100 PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center

Covered Entity Details

Entity Name

PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center

Subdivision Name

PORTSMOUTH COMMUNITY HEALTH CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH034100

Entity Address

664 Lincoln St
Portsmouth, VA 23704-4818

Grant Number

H80CS00729

Participating Start Date

1/1/1994

Last Recertification Date

1/31/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

HAGUE PHARMACY

Pharmacy Address

(CUSTOM COMPOUNDS INC)
400 GRESHAM DRIVE
MEDICAL TOWER
NORFOLK, VA 23507-1901

Pharmacy Comments

Contract Details

Approval Date

7/13/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/6/2018
Agreement registered in error

Contacts

Covered Entity Signing Official

Barbara Willis, CEO
(757) 393-6363

Contract Pharmacy Representative

Hague Pharmacy
Vish Patel, Owner
(757) 285-6001

Signed By Date

7/13/2018

340B Drug Pricing Program Database