Contract Pharmacy Details

SHAKAMAK HEALTH INC
FQHCLA351D GREENE COUNTY HEALTH, INC.

Covered Entity Details

Entity Name

GREENE COUNTY HEALTH, INC.

Subdivision Name

Greene County Health - Lonetree

Type

Health Center Program Look-Alike

340B ID

FQHCLA351D

Entity Address

1216 N. 1000 W.
Linton, IN 47441

Grant Number

LALCS31107

Participating Start Date

10/1/2017

Last Recertification Date

2/12/2018

Entity Termination Date

10/1/2018

Pharmacy Details

Pharmacy Name

SHAKAMAK HEALTH INC

Pharmacy Address

D/B/A SHAKAMAK PHARMACY
346 E MAIN ST
JASONVILLE, IN 47438

Pharmacy Comments

Contract Details

Approval Date

10/11/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Elizabeth Burrows, Interim CEO
(812) 699-4153

Contract Pharmacy Representative

shakamak pharmacy
traver lee wolf, owner
(812) 665-9760

Signed By Date

10/11/2017

340B Drug Pricing Program Database