Contract Pharmacy Details

JAMESTOWN PHARMACY
CH03406I PRIMARY HEALTH NETWORK, INC.

Covered Entity Details

Entity Name

PRIMARY HEALTH NETWORK, INC.

Subdivision Name

LINESVILLE HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH03406I

Entity Address

226 W Erie St
Linesville, PA 16424-9214

Grant Number

H80CS00663

Participating Start Date

1/1/2003

Last Recertification Date

2/15/2017

Entity Termination Date

4/1/2017

Pharmacy Details

Pharmacy Name

JAMESTOWN PHARMACY

Pharmacy Address

121 LIBERTY ST
JAMESTOWN, PA 16134-9117

Pharmacy Comments

Contract Details

Approval Date

4/23/2012

Contract Begin Date

5/2/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017

Contacts

Covered Entity Signing Official

John D. Laeng, CEO
(724) 342-3002 Ext: 215

Contract Pharmacy Representative

Bretton C. Wallberg, Owner
(724) 373-8533

Signed By Date

4/18/2012