Contract Pharmacy Details

APPLEBY'S DRUG STORE
CH030220G Broad Top Area Medical Center, Inc., The

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

APPLEBY'S DRUG STORE

Pharmacy Address

133 E. SHIRLEY ST.
MOUNT UNION, PA 17066

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

Appleby's Drug Store
Troy Parsons, owner
(814) 542-4412

Signed By Date

7/14/2024

340B Drug Pricing Program Database