Contract Pharmacy Details

GIANT EAGLE PHARMACY #0221
CHC12890-04 FAIRFIELD COMMUNITY HEALTH CENTER

Covered Entity Details

Entity Name

FAIRFIELD COMMUNITY HEALTH CENTER

Subdivision Name

Fairfield Community Health Center - Baltimore

Type

HRSA-Funded Health Center

340B ID

CHC12890-04

Entity Address

1055 W Market St STE H
Baltimore, OH 43105-1284

Grant Number

H80CS19595

Participating Start Date

1/1/2012

Last Recertification Date

1/30/2023

Entity Termination Date

10/1/2023

Pharmacy Details

Pharmacy Name

GIANT EAGLE PHARMACY #0221

Pharmacy Address

20160 CENTER RIDGE ROAD, SUITE 201
ROCKY RIVER, OH 44116

Pharmacy Comments

Contract Details

Approval Date

4/2/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lauree Althaus, Director of Finance
(740) 277-6043 Ext: 1001

Contract Pharmacy Representative

Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718

Signed By Date

4/2/2019

340B Drug Pricing Program Database