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MARTIN'S PHARMACY #6288
CH030220P 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
BTAMC, Inc. SHCMC Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH030220P
Entity Address
626 Water Street STE 2
Orbisonia, PA 17243
Grant Number
H80CS00330
Participating Start Date
10/1/2022
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MARTIN'S PHARMACY #6288
Pharmacy Address
221 GLIMCHER DR
DUNCANSVILLE, PA 16635
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Roth, CEO
(814) 635-7351
Contract Pharmacy Representative
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
4/11/2025
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