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PENNSYLVANIA CVS PHARMACY, L.L.C.
CH03122L N Penn Comprehensive Health Svcs
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Covered Entity Details
Entity Name
N Penn Comprehensive Health Svcs
Subdivision Name
Wellsboro Laurel Pediatric Center
Type
HRSA-Funded Health Center
340B ID
CH03122L
Entity Address
1B Main St
Wellsboro, PA 16901-1601
Grant Number
H80CS00682
Participating Start Date
1/1/2020
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01679
197 NORTH MAIN STREET
MANSFIELD PLAZA
MANSFIELD, PA 16933
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
Ronald M Gilbert, CFO
(570) 662-1955
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2020
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