Contract Pharmacy Details

DE MOTTE DRUGS, INC
CH058660 COMMUNITY HEALTHNET

Covered Entity Details

Entity Name

COMMUNITY HEALTHNET

Subdivision Name

GARY COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH058660

Entity Address

1021 W 5th Ave
Gary, IN 46402-1703

Grant Number

H80CS06665

Participating Start Date

10/1/2006

Last Recertification Date

2/5/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

DE MOTTE DRUGS, INC

Pharmacy Address

DBA: FAGEN PHARMACY #26
1195 E RIDGE RD
GRIFFITH, IN 46319

Pharmacy Comments

Contract Details

Approval Date

10/16/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/6/2017
Ownership change

Contacts

Covered Entity Signing Official

JANET SEABROOK, CEO
(219) 484-2442

Contract Pharmacy Representative

CVS
Jeff Noone, Director
(412) 660-1513

Signed By Date

10/16/2017