Contract Pharmacy Details

THE HOMETOWN PHARMACY
CH03406F PRIMARY HEALTH NETWORK, INC.

Covered Entity Details

Entity Name

PRIMARY HEALTH NETWORK, INC.

Subdivision Name

Kinsman Health Center

Type

HRSA-Funded Health Center

340B ID

CH03406F

Entity Address

8231 Main Street
Kinsman, OH 44428

Grant Number

H80CS00663

Participating Start Date

7/1/2008

Last Recertification Date

2/15/2017

Entity Termination Date

7/1/2017

Pharmacy Details

Pharmacy Name

THE HOMETOWN PHARMACY

Pharmacy Address

7160 WARREN-SHARON RD
BROOKFIELD, OH 44403

Pharmacy Comments

Contract Details

Approval Date

7/11/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2017

Contacts

Covered Entity Signing Official

John D. Laeng, CEO
(724) 342-3002 Ext: 215

Contract Pharmacy Representative

Ron McDermott, Sr Vice President
(330) 318-3926

Signed By Date

7/11/2013