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CCN AMERICA LP D/B/A COORDINATED CARE NE
CH04334AL CareConnect Health, Inc.
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Covered Entity Details
Entity Name
CareConnect Health, Inc.
Subdivision Name
CareConnect Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH04334AL
Entity Address
110 E 13th AVENUE
CORDELE, GA 31015-4245
Grant Number
H80CS00393
Participating Start Date
9/25/2017
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
CCN AMERICA LP D/B/A COORDINATED CARE NE
Pharmacy Address
110 E 13TH AVE STE A
CORDELE, GA 31015
Pharmacy Comments
Contract Details
Approval Date
10/17/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
CCN AMERICA LP
Thomas J. Pollack, Vice President and CFO
(412) 349-6303
Signed By Date
10/17/2019
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