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WEIS PHARMACY #30
CH030220G Broad Top Area Medical Center, Inc., The
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Covered Entity Details
Entity Name
Broad Top Area Medical Center, Inc., The
Subdivision Name
Broad Top Area Medical Center Mount Union
Type
HRSA-Funded Health Center
340B ID
CH030220G
Entity Address
95 S. Park St.
Mount Union, PA 17066-1334
Grant Number
H80CS00330
Participating Start Date
4/1/2018
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WEIS PHARMACY #30
Pharmacy Address
611 15TH ST
HUNTINGDON, PA 16652
Pharmacy Comments
Contract Details
Approval Date
7/14/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Roth, CEO
(814) 635-7351
Contract Pharmacy Representative
Weis Markets
Nick Cicco, Vice President of Pharmacy
(570) 286-3201
Signed By Date
7/14/2024
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