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ANDREW BROWN'S DRUG STORE
FQHCLA394F Wright Center Medical Group, P.C., The
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Covered Entity Details
Entity Name
Wright Center Medical Group, P.C., The
Subdivision Name
The Wright Center for Community Health Ryan White Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA394F
Entity Address
640 Madison Ave
Scranton, PA 18510-1631
Grant Number
LALCS33109
Participating Start Date
10/1/2019
Last Recertification Date
2/6/2020
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
ANDREW BROWN'S DRUG STORE
Pharmacy Address
1502 PITTSTON AVE
SCRANTON, PA 18505-1668
Pharmacy Comments
Contract Details
Approval Date
9/3/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Maria Montoro Edwards, Vice President of Grants & Strategic Initiatives
(570) 343-2383 Ext: 2091
Contract Pharmacy Representative
ANDREW BROWN'S DRUG STORE
MICHAEL BROWN, PRESIDENT
(570) 840-8600
Signed By Date
7/11/2019
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