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HARBOR DRUGS, INC.
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
HARBOR DRUGS, INC.
Pharmacy Address
DBA FAGEN PHARMACY, #23
2106 BROADWAY ST.
EAST CHICAGO, IN 46312
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
9/30/2017
Ownership change
Contacts
Covered Entity Signing Official
Aileen Wehren, VP Systems Administration
(219) 476-4567
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2017
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