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EAST SIDE PRESCRIPTION SHOP
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26566-00
Entity Address
8931 E. 30th Street
Indianapolis, IN 46219-1501
Grant Number
H80CS26566
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
EAST SIDE PRESCRIPTION SHOP
Pharmacy Address
5317 EAST 16TH STREET
INDIANAPOLIS, IN 46218
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2019
Ownership change
Contacts
Covered Entity Signing Official
Michael Dale, CFO
(317) 934-0751
Contract Pharmacy Representative
East Side Prescription Shop
Jeffrey McLaughlin, Owner
(317) 359-8278
Signed By Date
1/15/2018
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