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IC PHARMACY LLC
CH03044AD Primary Care Health Services Inc
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Covered Entity Details
Entity Name
Primary Care Health Services Inc
Subdivision Name
PRIMARY CARE HEALTH SERVICES, INC. Alma Illery Medical Center
Type
HRSA-Funded Health Center
340B ID
CH03044AD
Entity Address
7227 Hamilton Ave
Pittsburgh, PA 15208
Grant Number
H80CS00714
Participating Start Date
1/2/2020
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
IC PHARMACY LLC
Pharmacy Address
AMAZON PHARMACY #004
34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYN, NY 11232
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
jerome gloster, CEO
(412) 244-4700 Ext: 4980
Contract Pharmacy Representative
AMAZON PHARMACY
JOHN M LAVIN, MANAGING OFFICER
(602) 793-8552
Signed By Date
7/11/2024
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