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PERSON STREET PHARMACY OF RALEIGH INC
CH04100A WAKE HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
WAKE HEALTH SERVICES, INC.
Subdivision Name
Southeast Raleigh - South
Type
HRSA-Funded Health Center
340B ID
CH04100A
Entity Address
1011 Rock Quarry Rd
Raleigh, NC 27610-3825
Grant Number
H80CS00087
Participating Start Date
7/1/2001
Last Recertification Date
3/8/2016
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
PERSON STREET PHARMACY OF RALEIGH INC
Pharmacy Address
702 NORTH PERSON STREET
RALEIGH, NC 27604
Pharmacy Comments
Contract Details
Approval Date
3/18/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
Penella M. Washington, CEO
(919) 250-2923
Contract Pharmacy Representative
Michael James, Owner
(919) 832-8671
Signed By Date
2/28/2013
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