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STEPHENS PHARMACY
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
STEPHENS PHARMACY
Pharmacy Address
1101 MAIN STREET
HONESDALE, PA 18431
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frederick Jackson, Executive Director
(570) 253-8450
Contract Pharmacy Representative
Stephens Pharmacy
Todd Stephens, Owner
(570) 253-7700
Signed By Date
4/15/2016
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