Contract Pharmacy Details

WEIS PHARMACY #30
CH030220F BROAD TOP AREA MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

BROAD TOP AREA MEDICAL CENTER, INC.

Subdivision Name

BROAD TOP AREA MEDICAL CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH030220F

Entity Address

4133 MEDICAL CENTER DRIVE
BROAD TOP, PA 16621-9001

Grant Number

H80CS00330

Participating Start Date

4/1/2017

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

WEIS PHARMACY #30

Pharmacy Address

611 15TH ST
HUNTINGDON, PA 16652

Pharmacy Comments

Contract Details

Approval Date

7/13/2020

Contract Begin Date

7/13/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Roth, CEO
(814) 635-7351

Contract Pharmacy Representative

Weis Markets
Nick Cicco, Vice President of Pharmacy
(570) 286-3201

Signed By Date

7/13/2020

340B Drug Pricing Program Database