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EXPRESS SCRIPTS PHARMACY, INC.
CH010850 COOS COUNTY FAMILY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COOS COUNTY FAMILY HEALTH SERVICES, INC.
Subdivision Name
COOS COUNTY FAMILY HEALTH SVCS
Type
HRSA-Funded Health Center
340B ID
CH010850
Entity Address
133 Pleasant St
Berlin, NH 03570-2006
Grant Number
H80CS00508
Participating Start Date
7/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
4750 E. 450 S.
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KEN GORDON, CEO
(603) 752-2040 Ext: 4018
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
1/14/2021
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