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ST MARY'S PHARMACY INC
CH03230D KEYSTONE RURAL HEALTH CONSORTIA INC
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Covered Entity Details
Entity Name
KEYSTONE RURAL HEALTH CONSORTIA INC
Subdivision Name
CAMERON COUNTY DENTAL CTR
Type
HRSA-Funded Health Center
340B ID
CH03230D
Entity Address
90 E 2ND ST
EMPORIUM, PA 15834-1302
Grant Number
H80CS00688
Participating Start Date
10/1/2014
Last Recertification Date
1/29/2024
Pharmacy Details
Pharmacy Name
ST MARY'S PHARMACY INC
Pharmacy Address
4 RAILROAD ST
SAINT MARYS, PA 15857
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristie Bennardi, CEO
(814) 486-1115
Contract Pharmacy Representative
St. Mary's Pharmacy
Frank Straub, CFO/SEC
(814) 834-3017
Signed By Date
4/15/2020
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