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PHILLIPS DRUG
FQHCLA393A Neighborhood Health Center, INC
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Covered Entity Details
Entity Name
Neighborhood Health Center, INC
Subdivision Name
Neighborhood Health Center - Union County Medical Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA393A
Entity Address
950 N Market St
Liberty, IN 47353-8496
Grant Number
LALCS32717
Participating Start Date
4/1/2020
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
PHILLIPS DRUG
Pharmacy Address
631 E MAIN ST
RICHMOND, IN 47374-4309
Pharmacy Comments
Contract Details
Approval Date
1/16/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carrie N Miles, CEO
(765) 965-4299
Contract Pharmacy Representative
Phillips Drugs
Peter Zaleski, Pharmacist/owner
(765) 960-5547
Signed By Date
1/13/2020
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