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GIANT EAGLE PHARMACY #0039
CH03170Q CENTERVILLE CLINIC INC
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Covered Entity Details
Entity Name
CENTERVILLE CLINIC INC
Subdivision Name
Centerville Clinics - City Mission Site
Type
HRSA-Funded Health Center
340B ID
CH03170Q
Entity Address
84 W Wheeling St
Washington, PA 15301-6918
Grant Number
H80CS00705
Participating Start Date
7/1/2020
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #0039
Pharmacy Address
331 WASHINGTON ROAD
WASHINGTON, PA 15301
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100
Contract Pharmacy Representative
Giant Eagle
Avonlea Firda, 340B Manager
(412) 967-3707
Signed By Date
10/7/2024
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