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PRN PHARMACEUTICAL SERVICES, LP
FQHCLA361 ADULT AND CHILD HEALTH INC
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Covered Entity Details
Entity Name
ADULT AND CHILD HEALTH INC
Subdivision Name
Adult and Child Health - Irvington
Type
Health Center Program Look-Alike
340B ID
FQHCLA361
Entity Address
5839 E. Washington Street
Indianapolis, IN 46219
Grant Number
LALCS31537
Participating Start Date
4/1/2018
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
PRN PHARMACEUTICAL SERVICES, LP
Pharmacy Address
OMNICARE OF INDIANAPOLIS
8351 ROCKVILLE RD
INDIANAPOLIS, IN 46234
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jessica Stembel, Chief Clinical Officer
(317) 494-0739
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2024
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