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WAL-MART PHARMACY 10-2664
CH03406A PRIMARY HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
PRIMARY HEALTH NETWORK, INC.
Subdivision Name
FARRELL HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH03406A
Entity Address
602 Roemer Blvd
Farrell, PA 16121-1902
Grant Number
H80CS00663
Participating Start Date
1/1/2003
Last Recertification Date
2/26/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2664
Pharmacy Address
21920 ROUTE #119
PUNXSUTAWNEY, PA 15767
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John D. Laeng, CEO
(724) 342-3002 Ext: 215
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/15/2014
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