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ULTRA CARE PHARMACY
CHC10591-02 COMMUNITY CLINIC, INC.
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Covered Entity Details
Entity Name
COMMUNITY CLINIC, INC.
Subdivision Name
CCI-GAITHERSBURG
Type
HRSA-Funded Health Center
340B ID
CHC10591-02
Entity Address
220 GIRARD ST
Suite 100
GAITHERSBURG, MD 20877
Grant Number
H80CS10591
Participating Start Date
7/1/2009
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ULTRA CARE PHARMACY
Pharmacy Address
UR CARE PHARMACY MD LLC
12619 WISTERIA DR STE A
GERMANTOWN, MD 20874-5259
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Ownership change
Contacts
Covered Entity Signing Official
Sonya J. Bruton, CEO and President
(240) 839-5107
Contract Pharmacy Representative
Ultra Care Pharmacy
Dipen Patel, Pharmacist
(301) 569-6464
Signed By Date
1/14/2021
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