Contract Pharmacy Details

MEDEXPRESS PHARMACY LTD
CHC28972-03 AFFINITY HEALTH CENTER

Covered Entity Details

Entity Name

AFFINITY HEALTH CENTER

Subdivision Name

Catawba Care Fort Mill Site

Type

HRSA-Funded Health Center

340B ID

CHC28972-03

Entity Address

120 ELLIOTT ST E
FORT MILL, SC 29715-1848

Grant Number

H80CS28972

Participating Start Date

1/1/2016

Last Recertification Date

2/23/2021

Entity Termination Date

1/1/2022

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

1/1/2022
Covered Entity Terminated

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