Contract Pharmacy Details

ULTRA CARE PHARMACY
CHC10591-14 Community Clinic, Inc., The

Covered Entity Details

Entity Name

Community Clinic, Inc., The

Subdivision Name

CCI-Rockville

Type

HRSA-Funded Health Center

340B ID

CHC10591-14

Entity Address

2 Taft Ct
Rockville, MD 20850-1390

Grant Number

H80CS10591

Participating Start Date

7/1/2021

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

ULTRA CARE PHARMACY

Pharmacy Address

UR CARE PHARMACY MD LLC
12619 WISTERIA DR STE A
GERMANTOWN, MD 20874-5259

Pharmacy Comments

Contract Details

Approval Date

7/14/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Ownership change

Contacts

Covered Entity Signing Official

Sonya J. Bruton, CEO and President
(240) 839-5107

Contract Pharmacy Representative

Ultra Care Pharmacy
Dipen Patel, Pharmacist
(301) 569-6464

Signed By Date

7/14/2021

340B Drug Pricing Program Database