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GIANT EAGLE PHARMACY #4034
CHC33659-02 MY COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
MY COMMUNITY HEALTH CENTER
Subdivision Name
SE Community Market and Health Center
Type
HRSA-Funded Health Center
340B ID
CHC33659-02
Entity Address
1318 Gonder Ave SE UNIT 1
Canton, OH 44707-3450
Grant Number
H80CS33659
Participating Start Date
1/1/2025
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #4034
Pharmacy Address
608 RAFF ROAD SW
CANTON, OH 44710
Pharmacy Comments
Contract Details
Approval Date
4/28/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Juan Paulo Afable, CEO
(502) 509-8987
Contract Pharmacy Representative
Giant Eagle
Stacey Tierney, Pharmacy District Manager
(330) 874-3511
Signed By Date
4/28/2025
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