Contract Pharmacy Details

JAMESTOWN PHARMACY
CH03406AP PRIMARY HEALTH NETWORK, INC.

Covered Entity Details

Entity Name

PRIMARY HEALTH NETWORK, INC.

Subdivision Name

Ashtabula Community Health Center

Type

HRSA-Funded Health Center

340B ID

CH03406AP

Entity Address

5266 State Route 45
Rome, OH 44085-9404

Grant Number

H80CS00663

Participating Start Date

4/1/2011

Last Recertification Date

2/26/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

JAMESTOWN PHARMACY

Pharmacy Address

121 LIBERTY ST
JAMESTOWN, PA 16134-9117

Pharmacy Comments

Contract Details

Approval Date

4/23/2012

Contract Begin Date

5/2/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

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