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DELIVERCARERX PHARMACY LLC
CHC28348-00 APPALACHIAN MOUNTAIN COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
APPALACHIAN MOUNTAIN COMMUNITY HEALTH CENTERS
Subdivision Name
Dale Fell Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28348-00
Entity Address
77 McDowell Street
Asheville, NC 28801-4435
Grant Number
H80CS28348
Participating Start Date
10/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
DELIVERCARERX PHARMACY LLC
Pharmacy Address
DELIVERCARERX PHARMACY LLC
1471 E BUSINESS CENTER DR
STE 200
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
4/6/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/3/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Reuben J Pettiford, President and CEO
(828) 202-5335
Contract Pharmacy Representative
Agape
Dave Krishna, CEO
(847) 965-1600
Signed By Date
4/6/2018
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