Contract Pharmacy Details

CLINIC PHARMACY
CHC28971-00 PANHANDLE COUNSELING AND HEALTH CENTER, INC.

Covered Entity Details

Entity Name

PANHANDLE COUNSELING AND HEALTH CENTER, INC.

Subdivision Name

Pathways - Panhandle Counseling and Health Center

Type

HRSA-Funded Health Center

340B ID

CHC28971-00

Entity Address

5170 Patricia Blvd
Guymon, OK 73942

Grant Number

H80CS28971

Participating Start Date

4/1/2016

Last Recertification Date

2/17/2017

Entity Termination Date

4/1/2017

Pharmacy Details

Pharmacy Name

CLINIC PHARMACY

Pharmacy Address

1210 N LELIA ST
P O BOX 1590
GUYMON, OK 73942-3647

Pharmacy Comments

Contract Details

Approval Date

4/20/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/12/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Sarah Wagner, CEO
(580) 338-0072

Contract Pharmacy Representative

Clinic Pharmacy
Chelle Melton, Owner/DPh
(580) 338-3339

Signed By Date

4/20/2016

340B Drug Pricing Program Database