Contract Pharmacy Details

PARK AVENUE PHARMACY
HV00668 KEYSTONE HIV PROGRAM

Covered Entity Details

Entity Name

KEYSTONE HIV PROGRAM

Subdivision Name

Type

Ryan White Part C

340B ID

HV00668

Entity Address

111 Chambers Hill Drive, Suite 102
Chambersburg, PA 17201

Grant Number

H76HA00668

Participating Start Date

1/1/2010

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

PARK AVENUE PHARMACY

Pharmacy Address

220 PARK AVE
CHAMBERSBURG, PA 17201

Pharmacy Comments

Contract Details

Approval Date

12/5/2011

Contract Begin Date

12/5/2011

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

JOANNE COCHRAN, PRESIDENT AND CEO
(717) 709-7906

Contract Pharmacy Representative

Park Ave Pharmacy
Jenny Hopple, Owner
(717) 264-7312

Signed By Date

11/18/2011

340B Drug Pricing Program Database