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RECEPT PHARMACY #1
CH05290K COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE
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Covered Entity Details
Entity Name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE
Subdivision Name
Broadway Street Clinic
Type
HRSA-Funded Health Center
340B ID
CH05290K
Entity Address
621 Broadway Street
Portsmouth, OH 45662
Grant Number
H80CS00399
Participating Start Date
10/1/2014
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
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