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FAGEN PHARMACY #31
CH0530920 HEALTHLINC INC
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Covered Entity Details
Entity Name
HEALTHLINC INC
Subdivision Name
HealthLinc Valparaiso
Type
HRSA-Funded Health Center
340B ID
CH0530920
Entity Address
1001 Sturdy Rd
Valparaiso, IN 46383-4126
Grant Number
H80CS06662
Participating Start Date
1/1/2004
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
FAGEN PHARMACY #31
Pharmacy Address
DEMOTTE DRUGS INC.
16831 TORRENCE AVENUE
LANSING, IL 60438
Pharmacy Comments
Contract Details
Approval Date
4/19/2010
Contract Begin Date
6/1/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/9/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
BETH WROBEL, CEO
(219) 465-9500
Contract Pharmacy Representative
Gerald A. Fagen, President
(219) 987-6468
Signed By Date
4/7/2010
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