Contract Pharmacy Details

MEDEXPRESS PHARMACY LTD
CHC28972-04 AFFINITY HEALTH CENTER

Covered Entity Details

Entity Name

AFFINITY HEALTH CENTER

Subdivision Name

Catawba Care Rock Hill Site

Type

HRSA-Funded Health Center

340B ID

CHC28972-04

Entity Address

410 E BLACK ST
ROCK HILL, SC 29730-5342

Grant Number

H80CS28972

Participating Start Date

1/1/2016

Last Recertification Date

2/7/2017

Entity Termination Date

10/1/2017

Pharmacy Details

Pharmacy Name

MEDEXPRESS PHARMACY LTD

Pharmacy Address

1431 W INNES STREET
SALISBURY, NC 28144

Pharmacy Comments

Contract Details

Approval Date

10/15/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2017

Contacts

Covered Entity Signing Official

Anita Case, Executive Director
(803) 909-9710

Contract Pharmacy Representative

Avita Drugs
KEITH FOX, CFO
(225) 236-1540

Signed By Date

10/15/2015