Contract Pharmacy Details

MANIFEST PHARMACY, LLC
CH015110 HEALTH ACCESS NETWORK

Covered Entity Details

Entity Name

HEALTH ACCESS NETWORK

Subdivision Name

Health Access Network Lincoln

Type

HRSA-Funded Health Center

340B ID

CH015110

Entity Address

175 WEST BROADWAY
LINCOLN, ME 04457

Grant Number

H80CS02450

Participating Start Date

1/1/2004

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

MANIFEST PHARMACY, LLC

Pharmacy Address

1018 S BATESVILLE RD
STE 4A
GREER, SC 29650-5203

Pharmacy Comments

Contract Details

Approval Date

7/11/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/14/2016
Pharmacy closed

Contacts

Covered Entity Signing Official

Jeff Kirsch, CFO
(207) 794-6700

Contract Pharmacy Representative

Benjamin Walvoord, President
(864) 990-2880

Signed By Date

7/11/2013