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EXACT CARE PHARMACY, LLC
CH057260B KENOSHA COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
KENOSHA COMMUNITY HEALTH CENTER INC
Subdivision Name
Kenosha Community Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH057260B
Entity Address
6226 14th Avenue
Kenosha, WI 53143
Grant Number
H80CS00662
Participating Start Date
10/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
EXACT CARE PHARMACY, LLC
Pharmacy Address
8333 ROCKSIDE RD
CLEVELAND, OH 44125
Pharmacy Comments
Contract Details
Approval Date
12/30/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gary Moss, Chief Financial Officer
(262) 764-3619
Contract Pharmacy Representative
PharmaForce
Michelle Tuttle, Implementation Manager
(740) 403-1023
Signed By Date
12/30/2021
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