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MIDTOWN MEDICENTER PHARMACY
FQHCLA393 Neighborhood Health Center, INC
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Covered Entity Details
Entity Name
Neighborhood Health Center, INC
Subdivision Name
Neighborhood Health Center, Inc.
Type
Health Center Program Look-Alike
340B ID
FQHCLA393
Entity Address
101 S 10th St
Richmond, IN 47374-5547
Grant Number
LALCS32717
Participating Start Date
10/1/2019
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MIDTOWN MEDICENTER PHARMACY
Pharmacy Address
11 S 9TH ST
RICHMOND, IN 47374-5503
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/2/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Carrie N Miles, CEO
(765) 965-4299
Contract Pharmacy Representative
EDS MEDICENTER PHARMACY
Steve Sommer, Manager Contracting & Channel Management
(618) 826-2511
Signed By Date
1/10/2020
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