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WEIS PHARMACY #30
CH030220 BROAD TOP AREA MEDICAL CENTER
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Covered Entity Details
Entity Name
BROAD TOP AREA MEDICAL CENTER
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH030220
Entity Address
RT 913
BROAD TOP, PA 16621-9001
Grant Number
H80CS00330
Participating Start Date
4/1/2003
Last Recertification Date
1/28/2020
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
WEIS PHARMACY #30
Pharmacy Address
611 15TH ST
HUNTINGDON, PA 16652
Pharmacy Comments
Contract Details
Approval Date
7/11/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Melissa Walls, CEO
(814) 635-7351 Ext: 1401
Contract Pharmacy Representative
WEIS MARKETS
Rick Seipp, Vice President of Pharmacy
(570) 863-2812
Signed By Date
7/11/2016
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