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DEMOTTE DRUGS
CHC29005-00 PORTER STARKE SERVICES INC
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Covered Entity Details
Entity Name
PORTER STARKE SERVICES INC
Subdivision Name
Porter Starke Services Inc DBA Marram Health Center
Type
HRSA-Funded Health Center
340B ID
CHC29005-00
Entity Address
3229 Broadway Ste 205
Gary, IN 46409
Grant Number
H80CS29005
Participating Start Date
4/1/2016
Last Recertification Date
1/29/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
DEMOTTE DRUGS
Pharmacy Address
FAGEN PHARMACY #2
3892 W. STATE ROAD #10
WHEATFIELD, IN 46392
Pharmacy Comments
Contract Details
Approval Date
3/3/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/22/2017
Ownership change
Contacts
Covered Entity Signing Official
Aileen Wehren, VP Systems Administration
(219) 476-4567
Contract Pharmacy Representative
Gerald A. Fagen, President
(219) 987-6468
Signed By Date
3/3/2016
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