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MOOSE PHARMACY OF KANNAPOLIS
CH044523G Cabarrus Community Health Centers, Inc.
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Covered Entity Details
Entity Name
Cabarrus Community Health Centers, Inc.
Subdivision Name
Temporary Site - Mobile Van (RV Testing Unit)
Type
HRSA-Funded Health Center
340B ID
CH044523G
Entity Address
202D Mcgill Ave NW
Concord, NC 28025-4615
Grant Number
H80CS06652
Participating Start Date
10/1/2020
Last Recertification Date
1/30/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
MOOSE PHARMACY OF KANNAPOLIS
Pharmacy Address
1113 N MAIN ST
KANNAPOLIS, NC 28081-2256
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Don Holloman, CEO
(704) 792-2203
Contract Pharmacy Representative
Moose Pharmacy
Joseph Moose, Owner
(704) 784-9613
Signed By Date
4/15/2024
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