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MODEN-GIROUX INC
CH020180 OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
Subdivision Name
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH020180
Entity Address
300 West Ave
Brockport, NY 14420-1118
Grant Number
H80CS00170
Participating Start Date
10/14/2008
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MODEN-GIROUX INC
Pharmacy Address
DBA/MIDDLEPORT FAMILY HEALTH C
81 ROCHESTER RD PO BOX 188
MIDDLEPORT, NY 14105-0188
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
9/17/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ursula Staneff, CFIO
(585) 637-3905 Ext: 224
Contract Pharmacy Representative
Middleport Family Health Center
Stephen Giroux, Owner
(716) 735-3261
Signed By Date
1/4/2021
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