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ACARIAHEALTH PHARMACY #26, INC
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26566-00
Entity Address
8931 E. 30th Street
Indianapolis, IN 46219-1501
Grant Number
H80CS26566
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY #26, INC
Pharmacy Address
8715 HENDERSON RD
TAMPA, FL 33634
Pharmacy Comments
Contract Details
Approval Date
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dale Marion, 340B Program Manager
(317) 552-0690
Contract Pharmacy Representative
Acaria Health
Philip Gofman, Regional VP
(917) 312-5263
Signed By Date
4/9/2024
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