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GEORGE'S PHARMACY EAST SIDE, LLC
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26566-00
Entity Address
8931 E. 30th Street
Indianapolis, IN 46219-1501
Grant Number
H80CS26566
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GEORGE'S PHARMACY EAST SIDE, LLC
Pharmacy Address
5543 E WASHINGTON ST
INDIANAPOLIS, IN 46219
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dale Marion, 340B Program Manager
(317) 552-0690
Contract Pharmacy Representative
George's Family Pharmacy, Inc.
Blake Gillman, President & CEO
(765) 647-6251
Signed By Date
4/6/2021
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