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BLOSS PHARMACY, INC
CH03122P North Penn Comprehensive Health Services
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Covered Entity Details
Entity Name
North Penn Comprehensive Health Services
Subdivision Name
Laurel Dental - Blossburg
Type
HRSA-Funded Health Center
340B ID
CH03122P
Entity Address
116 Seymour St
Blossburg, PA 16912-1418
Grant Number
H80CS00682
Participating Start Date
10/1/2021
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
BLOSS PHARMACY, INC
Pharmacy Address
2 RIVERSIDE PLZ
BLOSSBURG, PA 16912-1137
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ronald M Gilbert, CFO
(570) 828-3869
Contract Pharmacy Representative
BLOSS PHARMACY
Patrick Bauman, President
(570) 638-2820
Signed By Date
4/15/2022
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