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WAGNER'S CLIFFORD PHARMACY
CH03048G B-K Health Center, Inc.
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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
WAGNER'S CLIFFORD PHARMACY
Pharmacy Address
1638 STATE ROUTE 106
PO BOX 189
CLIFFORD, PA 18413
Pharmacy Comments
Contract Details
Approval Date
8/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary W. Wetherall, CEO
(570) 278-5161
Contract Pharmacy Representative
Endless Mountains Pharmacy
William Wagner, President
(570) 222-7500
Signed By Date
8/20/2020
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