Contract Pharmacy Details

FAGEN PHARMACY #36
CH058660A COMMUNITY HEALTHNET

Covered Entity Details

Entity Name

COMMUNITY HEALTHNET

Subdivision Name

Calumet High School

Type

HRSA-Funded Health Center

340B ID

CH058660A

Entity Address

3900 Calhoun St
Gary, IN 46408-1753

Grant Number

H80CS06665

Participating Start Date

4/1/2010

Last Recertification Date

2/5/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

FAGEN PHARMACY #36

Pharmacy Address

1350 BROADWAY STREET
GARY, IN 46407

Pharmacy Comments

4/30/10 UPDATED ADDR (WAS 504 BROADWAY)

Contract Details

Approval Date

6/21/2010

Contract Begin Date

6/21/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/6/2017
Ownership change

Contacts

Covered Entity Signing Official

JANET SEABROOK, CEO
(219) 484-2442

Contract Pharmacy Representative

Gerald A. Fagen, President
(219) 987-6468

Signed By Date

5/25/2010