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GIANT EAGLE PHARMACY #4089
CHC33659-00 My Community Health Center
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Covered Entity Details
Entity Name
My Community Health Center
Subdivision Name
My Community Health Center - Canton
Type
HRSA-Funded Health Center
340B ID
CHC33659-00
Entity Address
2600 7th St. SW
Canton, OH 44710-0000
Grant Number
H80CS33659
Participating Start Date
4/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #4089
Pharmacy Address
515 UNION AVENUE
DOVER, OH 44622
Pharmacy Comments
Contract Details
Approval Date
1/4/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/6/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Terry Regula, CEO
(330) 363-3179
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
1/4/2021
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