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HICKORY FAMILY PHARMACY LLC
STD286021 AIDS Leadership Foothills-area Alliance
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Covered Entity Details
Entity Name
AIDS Leadership Foothills-area Alliance
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD286021
Entity Address
1120 Fairgrove Church Rd
Suite 28
Hickory, NC 28602
Grant Number
NH25PS005152-05-00
Participating Start Date
4/1/2018
Last Recertification Date
5/11/2024
Pharmacy Details
Pharmacy Name
HICKORY FAMILY PHARMACY LLC
Pharmacy Address
HICKORY FAMILY PHARMACY LLC.
1501 TATE BLVD SE STE 102
HICKORY, NC 28602-1385
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Kliesch, CEO
(828) 237-1577
Contract Pharmacy Representative
Hickory Family Pharmacy
Maurice Batshon, Pharmacy General Manager
(828) 324-4630
Signed By Date
10/14/2019
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