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GIANT EAGLE PHARMACY #1619
CH03075B EAST LIBERTY FAMILY HEALTH CARE CENTER
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Covered Entity Details
Entity Name
EAST LIBERTY FAMILY HEALTH CARE CENTER
Subdivision Name
Hosanna House - Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH03075B
Entity Address
807 Wallace Street
Wilkinsburg, PA 15221-2312
Grant Number
H80CS00664
Participating Start Date
10/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #1619
Pharmacy Address
EDGEWOOD TOWNE CENTER
1705 SOUTH BRADDOCK AVE
PITTSBURGH, PA 15218
Pharmacy Comments
Contract Details
Approval Date
7/8/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rodney B. Jones Sr., CEO
(412) 362-6353
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
7/8/2016
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