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GOOLRICK'S MODERN PHCY
STD22408 FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
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Covered Entity Details
Entity Name
FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD22408
Entity Address
4343 Plank Road
SUITE 100
FREDERICKSBURG, VA 22407
Grant Number
NU62PS924552
Participating Start Date
10/1/2017
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
GOOLRICK'S MODERN PHCY
Pharmacy Address
901 CAROLINE ST
FREDERICKSBURG, VA 22401
Pharmacy Comments
Contract Details
Approval Date
1/9/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph W Lyttle, Executive Director
(540) 907-4555 Ext: 120
Contract Pharmacy Representative
Goolrick's Pharmacy
Christopher Conder, Owner
(540) 373-3411
Signed By Date
1/9/2019
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