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PENNSYLVANIA CVS PHARMACY, L.L.C.
CHC08760-00 WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08760-00
Entity Address
600 Maple Ave
6
HONESDALE, PA 18431
Grant Number
H80CS08760
Participating Start Date
1/1/2010
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01587
202 4TH STREET
HONESDALE, PA 18431
Pharmacy Comments
Contract Details
Approval Date
1/5/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frederick Jackson, Executive Director
(570) 253-8450
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
1/5/2015
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