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COORDINATED CARE NETWORK PHARMACY
CH03290E Delaware Valley Community Health, Inc.
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Covered Entity Details
Entity Name
Delaware Valley Community Health, Inc.
Subdivision Name
Fairmount Primary Care Center at Girard Medical Center
Type
HRSA-Funded Health Center
340B ID
CH03290E
Entity Address
820 West Thompson Street
Philadelphia, PA 19122-4212
Grant Number
H80CS00833
Participating Start Date
1/1/2019
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
249 S 13TH ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott McNeal, DO, President and CEO
(215) 684-5344
Contract Pharmacy Representative
CCN AMERICA LP
Thomas J. Pollack, Vice President and CFO
(412) 349-6303
Signed By Date
10/11/2019
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