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CVS CAREMARK
FQHCLA344C Tri-County Family Medicine Program, Inc.
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Covered Entity Details
Entity Name
Tri-County Family Medicine Program, Inc.
Subdivision Name
TCFM Dansville
Type
Health Center Program Look-Alike
340B ID
FQHCLA344C
Entity Address
60 Red Jacket St Ste 1
Dansville, NY 14437-1758
Grant Number
LALCS00181
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
CVS CAREMARK
Pharmacy Address
DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706
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
Nicholas H Apostoleris, CSIO
(585) 432-2300
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2021
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