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LINESVILLE PHARMACY
CH03406Y PRIMARY HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
PRIMARY HEALTH NETWORK, INC.
Subdivision Name
JAMESTOWN HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH03406Y
Entity Address
865 E Jamestown Rd
Jamestown, PA 16134-9505
Grant Number
H80CS00663
Participating Start Date
10/1/2006
Last Recertification Date
2/26/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
LINESVILLE PHARMACY
Pharmacy Address
LINESVILLE PHARMACY INC
123 W ERIE ST
LINESVILLE, PA 16424
Pharmacy Comments
Contract Details
Approval Date
7/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John D. Laeng, CEO
(724) 342-3002 Ext: 215
Contract Pharmacy Representative
Bretton C. Wallberg, Owner
(724) 373-8533
Signed By Date
7/11/2013
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