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MOSHANNON VALLEY PHARMACY
CH03230D KEYSTONE RURAL HEALTH CONSORTIA INC
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Covered Entity Details
Entity Name
KEYSTONE RURAL HEALTH CONSORTIA INC
Subdivision Name
CAMERON COUNTY DENTAL CTR
Type
HRSA-Funded Health Center
340B ID
CH03230D
Entity Address
90 E 2ND ST
EMPORIUM, PA 15834-1302
Grant Number
H80CS00688
Participating Start Date
10/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MOSHANNON VALLEY PHARMACY
Pharmacy Address
402 E. SYCAMORE ROAD
P O BOX 292
SNOW SHOE, PA 16874
Pharmacy Comments
Contract Details
Approval Date
10/10/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristie Bennardi, Administrator
(814) 598-5513
Contract Pharmacy Representative
Bob Branstetter, Owner
(814) 387-4014
Signed By Date
10/10/2014
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