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GIANT EAGLE PHARMACY #4152
CH053086A Lifecare Family Health & Dental Center, Inc.
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Covered Entity Details
Entity Name
Lifecare Family Health & Dental Center, Inc.
Subdivision Name
Lincoln Street Health Center
Type
HRSA-Funded Health Center
340B ID
CH053086A
Entity Address
2725 Lincoln St E
Canton, OH 44707-2769
Grant Number
H80CS06654
Participating Start Date
4/1/2008
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #4152
Pharmacy Address
2032 LINCOLN WAY EAST
MASSILLON, OH 44646
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Janet C McPeek, CEO
(234) 521-7213
Contract Pharmacy Representative
Giant Eagle
Avonlea Firda, 340B Manager
(412) 967-3707
Signed By Date
1/14/2022
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