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LINESVILLE PHARMACY
CH03406F PRIMARY HEALTH NETWORK, INC.
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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
LINESVILLE PHARMACY
Pharmacy Address
LINESVILLE PHARMACY INC
123 W ERIE ST
LINESVILLE, PA 16424
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
Bretton C. Wallberg, Owner
(724) 373-8533
Signed By Date
7/11/2013
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