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ULTRA CARE PHARMACY
CHC10591-05 COMMUNITY CLINIC, INC., THE
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Covered Entity Details
Entity Name
COMMUNITY CLINIC, INC., THE
Subdivision Name
CCI-Greenbelt
Type
HRSA-Funded Health Center
340B ID
CHC10591-05
Entity Address
7615 Ora Glen Drive
Greenbelt, MD 20770-1004
Grant Number
H80CS10591
Participating Start Date
1/1/2014
Last Recertification Date
2/1/2024
Entity Termination Date
4/1/2025
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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