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GIANT EAGLE PHARMACY #8991
CHC30718-04 SIGNATURE HEALTH, INC.
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Covered Entity Details
Entity Name
SIGNATURE HEALTH, INC.
Subdivision Name
Signature Health Ashtabula Health Center
Type
HRSA-Funded Health Center
340B ID
CHC30718-04
Entity Address
4726 Main Ave.
Ashtabula, OH 44004
Grant Number
H80CS30718
Participating Start Date
7/1/2017
Last Recertification Date
2/22/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #8991
Pharmacy Address
2500 LOVI RD
FREEDOM, PA 15042
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/16/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Jonathan Albert Lee, CEO
(440) 953-9999 Ext: 705133
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
1/15/2019
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