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GIANT EAGLE PHARMACY #1664
CH056820 COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC
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Covered Entity Details
Entity Name
COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC
Subdivision Name
DBA LISBON COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH056820
Entity Address
7880 Lincole Pl
Lisbon, OH 44432-8322
Grant Number
H80CS00197
Participating Start Date
7/1/1997
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #1664
Pharmacy Address
2401 E. STATE STREET
SALEM, OH 44460
Pharmacy Comments
Contract Details
Approval Date
4/7/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jenna E Wonner, COO
(330) 424-7221 Ext: 103
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
4/7/2016
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