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BOSWELL PHARMACY SERVICES, LLC
STD460641 Indiana Department of Correction
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Covered Entity Details
Entity Name
Indiana Department of Correction
Subdivision Name
Pendleton Juvenile Correctional Facility
Type
Sexually Transmitted Diseases
340B ID
STD460641
Entity Address
9310 South State Road 67
Pendleton, IN 46064
Grant Number
NU51PS005165
Participating Start Date
7/15/2020
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
BOSWELL PHARMACY SERVICES, LLC
Pharmacy Address
131 SCHOOLHOUSE ROAD
P O BOX 266
JENNERSTOWN, PA 15547
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina E Reagle, CFO
(317) 232-5805
Contract Pharmacy Representative
Boswell Pharmacy Services
Gary Pribozie, Director of Purchasing
(814) 629-1397 Ext: 103
Signed By Date
7/15/2020
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