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CLINIC PHARMACY
CHC28971-02 Panhandle Counseling and Health Center, Inc.
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Covered Entity Details
Entity Name
Panhandle Counseling and Health Center, Inc.
Subdivision Name
Panhandle Counseling and Health Center Outreach Center
Type
HRSA-Funded Health Center
340B ID
CHC28971-02
Entity Address
1309 N East St
Guymon, OK 73942-3333
Grant Number
H80CS28971
Participating Start Date
1/1/2020
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
CLINIC PHARMACY
Pharmacy Address
1210 N LELIA ST
P O BOX 1590
GUYMON, OK 73942-3647
Pharmacy Comments
Contract Details
Approval Date
6/16/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sarah Wagner, CEO
(580) 338-0072
Contract Pharmacy Representative
Clinic Pharmacy
Chelle Melton, Owner/DPh
(580) 338-3339
Signed By Date
6/16/2023
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