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MEDCART SPECIALTY PHARMACY
CH010480 NORTHWEST COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
NORTHWEST COMMUNITY HEALTH CARE
Subdivision Name
DBA WellOne Primary Medical and Dental Care
Type
HRSA-Funded Health Center
340B ID
CH010480
Entity Address
36 BRIDGE WAY
PASCOAG, RI 02859
Grant Number
H80CS00308
Participating Start Date
10/1/2003
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MEDCART SPECIALTY PHARMACY
Pharmacy Address
32131 INDUSTRIAL RD.
LIVONIA, MI 48150
Pharmacy Comments
Contract Details
Approval Date
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peter Bancroft, President & CEO
(401) 285-5119
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
7/8/2021
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