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WILLIAMS BROS HEALTH CARE PHARMACY
FQHCLA359B Southern Indiana Community Health Care Inc
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Covered Entity Details
Entity Name
Southern Indiana Community Health Care Inc
Subdivision Name
Comprehensive Health Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA359B
Entity Address
420 W. Longest St.
Paoli, IN 47454
Grant Number
LALCS31528
Participating Start Date
1/1/2018
Last Recertification Date
2/19/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WILLIAMS BROS HEALTH CARE PHARMACY
Pharmacy Address
889 N GOSPEL ST STE 2
P.O. BOX 169
PAOLI, IN 47454-9217
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nancy Radcliff, CEO
(812) 723-3944
Contract Pharmacy Representative
WIlliams Brothers
Mark Williams, Owner
(812) 254-8731
Signed By Date
4/15/2019
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