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STONY CREEK PHARMACY
CHC00386-00 STONY CREEK COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
STONY CREEK COMMUNITY HEALTH CENTER INC
Subdivision Name
STONY CREEK COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CHC00386-00
Entity Address
12454 Hartley St
Stony Creek, VA 23882-3302
Grant Number
H80CS00386
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
STONY CREEK PHARMACY
Pharmacy Address
12451 MAIN STREET
P. O. BOX 185
STONY CREEK, VA 23882-0185
Pharmacy Comments
Contract Details
Approval Date
4/18/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lucy J Elder, Executive Director
(434) 246-3501
Contract Pharmacy Representative
Howard Otto Wachsmann, Owner
(434) 246-5191
Signed By Date
4/14/2014
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