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IC PHARMACY LLC
CHC08784-00 LAKES COMMUNITY HEALTH CENTER, INC., THE
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Covered Entity Details
Entity Name
LAKES COMMUNITY HEALTH CENTER, INC., THE
Subdivision Name
NorthLakes - Iron River
Type
HRSA-Funded Health Center
340B ID
CHC08784-00
Entity Address
7665 Us Highway 2
Iron River, WI 54847-4690
Grant Number
H80CS08784
Participating Start Date
7/1/2010
Last Recertification Date
2/10/2025
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
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Akl, COO
(715) 372-5001
Contract Pharmacy Representative
AMAZON PHARMACY
JOHN M LAVIN, MANAGING OFFICER
(602) 793-8552
Signed By Date
7/12/2024
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