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PENNSYLVANIA CVS PHARMACY, L.L.C.
CH031220 N PENN COMPREHENSIVE HEALTH SVCS
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Covered Entity Details
Entity Name
N PENN COMPREHENSIVE HEALTH SVCS
Subdivision Name
North Penn Comprehensive Health Services, Laurel Health Center Administration
Type
HRSA-Funded Health Center
340B ID
CH031220
Entity Address
40 W. Wellsboro St
Mansfield, PA 16933
Grant Number
H80CS00682
Participating Start Date
1/1/2009
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01600
88 BROOKLYN ST.
CARBONDALE, PA 18407
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
10/21/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ronald M Gilbert, CFO
(570) 662-1955
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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