Contract Pharmacy Details

RECEPT PHARMACY #1
CH05290G COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE

Covered Entity Details

Entity Name

COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE

Subdivision Name

PIKETON FAMILY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH05290G

Entity Address

7777 US HIGHWAY 23
PIKETON, OH 45661-9102

Grant Number

H80CS00399

Participating Start Date

11/7/2005

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

RECEPT PHARMACY #1

Pharmacy Address

800 8TH AVE STE 130
FORT WORTH, TX 76104

Pharmacy Comments

Contract Details

Approval Date

10/4/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/7/2021
Agreement registered in error

Contacts

Covered Entity Signing Official

Keith Pitts, President and Chief Executive Officer
(216) 770-3409 Ext: 7009

Contract Pharmacy Representative

Recept Pharmacy
Samantha Burford, Director of 340B Client Services
(817) 602-2332

Signed By Date

10/4/2021

340B Drug Pricing Program Database