Contract Pharmacy Details

VINIULTRARX
CHC10591-00 COMMUNITY CLINIC, INC.

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC.

Subdivision Name

CCI-Takoma Park

Type

HRSA-Funded Health Center

340B ID

CHC10591-00

Entity Address

7676 NEW HAMPSHIRE AVENUE
Suite 200
TAKOMA PARK, MD 20912

Grant Number

H80CS10591

Participating Start Date

4/1/2005

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

VINIULTRARX

Pharmacy Address

ULTRA CARE PHARMACY
12619 WISTERIA DR STE A
GERMANTOWN, MD 20874

Pharmacy Comments

Contract Details

Approval Date

9/29/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Sonya J. Bruton, CEO and President
(240) 839-5107

Contract Pharmacy Representative

Ultra Care Pharmacy
Dipen Patel, Pharmacist
(301) 569-6464

Signed By Date

9/29/2023

340B Drug Pricing Program Database