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KAUP PHARMACY
CH05064C Family Health Services of Darke County
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Covered Entity Details
Entity Name
Family Health Services of Darke County
Subdivision Name
New Madison Medical Center
Type
HRSA-Funded Health Center
340B ID
CH05064C
Entity Address
101 ANDERSON ST
NEW MADISON, OH 45346-9715
Grant Number
H80CS00419
Participating Start Date
4/1/2015
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
KAUP PHARMACY
Pharmacy Address
42 W MAIN ST
VERSAILLES, OH 45380-1214
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Pollick, Executive Director
(937) 548-3806
Contract Pharmacy Representative
Kaup Pharmacy
Jackie Briscoe, Owner
(937) 526-3337
Signed By Date
1/16/2024
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