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FRUTH PHARMACY #16
CH052900 COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
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Covered Entity Details
Entity Name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Subdivision Name
N/A
Type
HRSA-Funded Health Center
340B ID
CH052900
Entity Address
941 MARKET STREET
PIKETON, OH 45661
Grant Number
H80CS00399
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
FRUTH PHARMACY #16
Pharmacy Address
101 JAMES RD
WAVERLY, OH 45690-1017
Pharmacy Comments
Contract Details
Approval Date
7/22/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Keith Pitts, President and Chief Executive Officer
(216) 770-3409 Ext: 7009
Contract Pharmacy Representative
Fruth Pharmacy
Tom Willoughby, Chief Financial Officer
(304) 675-1612 Ext: 163
Signed By Date
7/22/2019
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