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PENINSULA COMMUNITY PHARMACY
CH10717A PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
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Covered Entity Details
Entity Name
PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Subdivision Name
Peninsula Community Health Services of Alaska
Type
HRSA-Funded Health Center
340B ID
CH10717A
Entity Address
230 East Marydale Ave
SOLDOTNA, AK 99669-7524
Grant Number
H80CS01139
Participating Start Date
10/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PENINSULA COMMUNITY PHARMACY
Pharmacy Address
230 E MARYDALE AVE
STE 100
SOLDOTNA, AK 99669
Pharmacy Comments
Contract Details
Approval Date
10/5/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/18/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Al Wall, CEO
(907) 260-7314
Contract Pharmacy Representative
Cardinal Health
Curtis Hartin, Dir. Community Health Center Pharmacies
(864) 430-0906
Signed By Date
10/5/2016
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