340B Drug Pricing Program Database
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PENNSYLVANIA CVS PHARMACY, L.L.C.
HV16214 Pennsylvania Western University
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Covered Entity Details
Entity Name
Pennsylvania Western University
Subdivision Name
PA Thrive Partnership - Clarion
Type
Ryan White Part C
340B ID
HV16214
Entity Address
1008 S. 5th Ave.
Suite 201
Clarion, PA 16214
Grant Number
H76HA48995
Participating Start Date
10/1/2003
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01680
700 MAIN STREET
CLARION, PA 16214
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/29/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Amy Heather Esterhuizen, GRANTS OFFICER
(814) 393-2162
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2021
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