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GOOD VALUE PHARMACY
CH057260B KENOSHA COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
KENOSHA COMMUNITY HEALTH CENTER INC
Subdivision Name
Kenosha Community Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH057260B
Entity Address
6226 14th Avenue
Kenosha, WI 53143
Grant Number
H80CS00662
Participating Start Date
10/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GOOD VALUE PHARMACY
Pharmacy Address
3207 80TH ST
SUITE 100
KENOSHA, WI 53142-4908
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Stampfl, Controller
(262) 771-3561
Contract Pharmacy Representative
Good Value Pharmacy
Alex Berce, President
(262) 658-8124
Signed By Date
7/10/2024
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