Contract Pharmacy Details

K MART PHARMACY #3420
CH052900 COMMUNITY ACTION COMMITTEE OF PIKE COUNTY

Covered Entity Details

Entity Name

COMMUNITY ACTION COMMITTEE OF PIKE COUNTY

Subdivision Name

N/A

Type

HRSA-Funded Health Center

340B ID

CH052900

Entity Address

941 MARKET STREET
PIKETON, OH 45661

Grant Number

H80CS00399

Participating Start Date

12/1/1992

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

K MART PHARMACY #3420

Pharmacy Address

225 WEST AVENUE
NEW BOSTON, OH 45662

Pharmacy Comments

Contract Details

Approval Date

7/26/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/5/2016
Pharmacy closed

Contacts

Covered Entity Signing Official

Gary B. Roberts, Executive Director
(740) 289-2371

Contract Pharmacy Representative

BI-LO
Jennifer Spears, Director Administration/Compliance
(904) 783-5183

Signed By Date

7/26/2016

340B Drug Pricing Program Database