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BOSWELL PHARMACY SERVICES, LLC
STD466281 Indiana Department of Correction
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Covered Entity Details
Entity Name
Indiana Department of Correction
Subdivision Name
South Bend Community Re-entry Center
Type
Sexually Transmitted Diseases
340B ID
STD466281
Entity Address
4650 Old Cleveland Road
South Bend, IN 46628
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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