Contract Pharmacy Details

REM CORPORATION
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

JANE PAULEY COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Jane Pauley Community Health Center

Type

HRSA-Funded Health Center

340B ID

CHC26566-00

Entity Address

8931 E. 30th Street
Indianapolis, IN 46219-1501

Grant Number

H80CS26566

Participating Start Date

4/1/2014

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

REM CORPORATION

Pharmacy Address

DBA COMMUNITY MEDICAL CENTER PHARM
1311 N. ARLINGTON AVE.
SUITE 101
INDIANAPOLIS, IN 46219

Pharmacy Comments

Contract Details

Approval Date

10/3/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/30/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Dale Marion, 340B Program Manager
(317) 552-0690

Contract Pharmacy Representative

DBA Community Medical Center Pharmacy
Michelle Long, Pharmacy Manager
(317) 356-6346

Signed By Date

10/3/2018

340B Drug Pricing Program Database