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GIANT EAGLE PHARMACY #0053
FQHCLA189 MON VALLEY COMMUNITY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
MON VALLEY COMMUNITY HEALTH SERVICES, INC.
Subdivision Name
SPHS FAMILY HEALTH COMPLEX
Type
Health Center Program Look-Alike
340B ID
FQHCLA189
Entity Address
2 EASTGATE AVENUE
MONESSEN, PA 15062
Grant Number
LALCS00065
Participating Start Date
9/9/2005
Last Recertification Date
2/8/2019
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #0053
Pharmacy Address
300 TRI-COUNTY LANE
BELLE VERNON, PA 15012
Pharmacy Comments
Contract Details
Approval Date
1/9/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
LUTHER SHEETS, COO
(724) 489-3100 Ext: 4114
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
1/9/2017
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