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WEST PINE PHARMACY
CH07170F FAMILY CARE HEALTH CENTERS
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Covered Entity Details
Entity Name
FAMILY CARE HEALTH CENTERS
Subdivision Name
FOREST PARK SOUTHEAST
Type
HRSA-Funded Health Center
340B ID
CH07170F
Entity Address
4352 MANCHESTER AVE
ST. LOUIS, MO 63110-2138
Grant Number
H80CS00492
Participating Start Date
7/1/2014
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WEST PINE PHARMACY
Pharmacy Address
FR HAEFNER, INC
11 N SARAH ST
SAINT LOUIS, MO 63108
Pharmacy Comments
Contract Details
Approval Date
10/4/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aramide Ayorinde, Chief Executive Officer
(314) 481-1615 Ext: 1315
Contract Pharmacy Representative
West Pine Pharmacy
Devin Dalpoas, President
(314) 533-1081
Signed By Date
10/4/2024
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