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BENTLEYVILLE MEDICINE SHOPPE
CH031700 CENTERVILLE CLINIC INC
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Covered Entity Details
Entity Name
CENTERVILLE CLINIC INC
Subdivision Name
CENTERVILLE CLINICS, INC.; Joseph Yablonski Memorial Clinic
Type
HRSA-Funded Health Center
340B ID
CH031700
Entity Address
1070 OLD NATIONAL PIKE
FREDERICKTOWN, PA 15333-2114
Grant Number
H80CS00705
Participating Start Date
4/1/1995
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
BENTLEYVILLE MEDICINE SHOPPE
Pharmacy Address
808 MAIN ST
BENTLEYVILLE, PA 15314-1214
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100
Contract Pharmacy Representative
Bentleyville Medicine Shoppe
John Crumrine, President
(724) 239-3600
Signed By Date
10/15/2021
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