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CRM-CANANDAIGUA, LLC
CH02207F ANTHONY L JORDAN HEALTH CORP
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Covered Entity Details
Entity Name
ANTHONY L JORDAN HEALTH CORP
Subdivision Name
Jordan Health at Andrews Terrace
Type
HRSA-Funded Health Center
340B ID
CH02207F
Entity Address
125 Saint Paul St
Rochester, NY 14604-1203
Grant Number
H80CS21582
Participating Start Date
7/1/2012
Last Recertification Date
2/18/2019
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
CRM-CANANDAIGUA, LLC
Pharmacy Address
CANANDAIGUA THE MEDICINE SHOPPE
75 VICTOR HEIGHTS PKWY STE C
VICTOR, NY 14564-8926
Pharmacy Comments
Contract Details
Approval Date
6/12/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
10/1/2017
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jonathan Clune, CFO
(585) 423-2813
Contract Pharmacy Representative
CRM Pharmacy
Jeff Hetrick, COO
(716) 830-2518
Signed By Date
6/12/2017
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