Contract Pharmacy Details

ACARIAHEALTH PHARMACY #12, INC.
CHC30718-07 Signature Health, Inc.

Covered Entity Details

Entity Name

Signature Health, Inc.

Subdivision Name

Signature Health Inc. Cleveland West

Type

HRSA-Funded Health Center

340B ID

CHC30718-07

Entity Address

14701 Detroit Ave.
STE 620
Lakewood, OH 44107

Grant Number

H80CS30718

Participating Start Date

10/1/2018

Last Recertification Date

2/22/2025

Pharmacy Details

Pharmacy Name

ACARIAHEALTH PHARMACY #12, INC.

Pharmacy Address

5 SKYLINE DR STE 240
HAWTHORNE, NY 10532-2166

Pharmacy Comments

Contract Details

Approval Date

7/16/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/14/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jonathan Albert Lee, CEO
(440) 953-9999 Ext: 705133

Contract Pharmacy Representative

AcariaHealth
Noel Thomas, Pharmacist in Charge
(800) 511-5144

Signed By Date

7/16/2018

340B Drug Pricing Program Database