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FOOD CITY PHARMACY #895
CH030740 ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
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Covered Entity Details
Entity Name
ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH030740
Entity Address
241 MONARCH RD
ST CHARLES, VA 24282
Grant Number
H80CS00604
Participating Start Date
10/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
FOOD CITY PHARMACY #895
Pharmacy Address
205 RIVERBEND DRIVE
SUITE 102
PENNINGTON GAP, VA 24277
Pharmacy Comments
Contract Details
Approval Date
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MALCOLM PERDUE, CEO
(276) 546-5310
Contract Pharmacy Representative
Food City
Connie Reed, Administrative Assistant
(276) 623-5100 Ext: 5738
Signed By Date
7/7/2017
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