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PENNSYLVANIA CVS PHARMACY, L.L.C.
CHC00495-03 Union Community Care
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Covered Entity Details
Entity Name
Union Community Care
Subdivision Name
Union Community Care at Welsh Mountain
Type
HRSA-Funded Health Center
340B ID
CHC00495-03
Entity Address
584 Springville Rd
New Holland, PA 17557-9564
Grant Number
H80CS00495
Participating Start Date
4/1/2023
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 2297
385 NORTH BROAD ST.
LITITZ, PA 17543
Pharmacy Comments
Contract Details
Approval Date
1/6/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jackie Concepcion, CEO
(717) 354-4711 Ext: 136
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/6/2020
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