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PETROLIA PHARMACY
CH03406AG PRIMARY HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
PRIMARY HEALTH NETWORK, INC.
Subdivision Name
Titusville Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH03406AG
Entity Address
120 S Martin St
Titusville, PA 16354-2169
Grant Number
H80CS00663
Participating Start Date
7/1/2010
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
PETROLIA PHARMACY
Pharmacy Address
296 CHURCH ST
PETROLIA, PA 16050
Pharmacy Comments
Contract Details
Approval Date
4/23/2012
Contract Begin Date
5/2/2012
Carve-In Effective Date
Contract Comments
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
4/18/2012
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