Contract Pharmacy Details

PENNSYLVANIA CVS PHARMACY, L.L.C.
CH03048G B-K Health Center, Inc.

Covered Entity Details

Entity Name

B-K Health Center, Inc.

Subdivision Name

Matthew W. Stahl Memorial Health Center

Type

HRSA-Funded Health Center

340B ID

CH03048G

Entity Address

498 S Main St, Ste D
Montrose, PA 18801-1880

Grant Number

H80CS00420

Participating Start Date

4/1/2016

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Pharmacy Address

CVS/PHARMACY #11422
177 ERIE BLVD
SUSQUEHANNA, PA 18847-2791

Pharmacy Comments

Contract Details

Approval Date

7/9/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/4/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Mary W. Wetherall, CEO
(570) 278-5161

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/9/2020

340B Drug Pricing Program Database