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PERIGON PHARMACY 360, LLC
STD15801 TruCare Internal Medicine & Infectious Diseases
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Covered Entity Details
Entity Name
TruCare Internal Medicine & Infectious Diseases
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD15801
Entity Address
135 Midway Drive
Suite B
DU BOIS, PA 15801
Grant Number
NH25PS005144
Participating Start Date
10/1/2019
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
PERIGON PHARMACY 360, LLC
Pharmacy Address
1120 STEVENSON MILL RD STE 200
CORAOPOLIS, PA 15108
Pharmacy Comments
Contract Details
Approval Date
8/5/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tuesdae Stainbrook, DO, MPH
(814) 371-2348
Contract Pharmacy Representative
Valeda Rx, LLC
Chris Antypas, President
(412) 498-9338
Signed By Date
7/15/2019
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