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GIANT EAGLE PHARMACY #6375
CHC12888-02 LORAIN COUNTY HEALTH & DENTISTRY
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Covered Entity Details
Entity Name
LORAIN COUNTY HEALTH & DENTISTRY
Subdivision Name
Lorain County Health & Dentistry
Type
HRSA-Funded Health Center
340B ID
CHC12888-02
Entity Address
1205 Broadway Ave.
Lorain, OH 44052-3409
Grant Number
H80CS12888
Participating Start Date
7/1/2013
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #6375
Pharmacy Address
320 MARKET DRIVE
ELYRIA, OH 44035
Pharmacy Comments
Contract Details
Approval Date
1/24/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
stephanie wiersma, CEO
(440) 233-0159
Contract Pharmacy Representative
GIANT EAGLE
Mike Bianco, President & CEO
(412) 967-3718
Signed By Date
1/24/2020
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