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ST MARY'S PHARMACY INC
CH03230C KEYSTONE RURAL HEALTH CONSORTIA INC
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Covered Entity Details
Entity Name
KEYSTONE RURAL HEALTH CONSORTIA INC
Subdivision Name
Johnsonburg Dental Center
Type
HRSA-Funded Health Center
340B ID
CH03230C
Entity Address
81 Clarion Rd
Johnsonburg, PA 15845-1656
Grant Number
H80CS00688
Participating Start Date
10/1/2014
Last Recertification Date
1/29/2024
Pharmacy Details
Pharmacy Name
ST MARY'S PHARMACY INC
Pharmacy Address
4 RAILROAD ST
SAINT MARYS, PA 15857
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristie Bennardi, CEO
(814) 486-1115
Contract Pharmacy Representative
Penn Highlands
Michelle Bennett, Director of Retail Pharmacy Operations
(814) 299-7553
Signed By Date
10/16/2023
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