Contract Pharmacy Details

COORDINATED CARE NETWORK PHARMACY
CHC26634-00 PHILADELPHIA FIGHT

Covered Entity Details

Entity Name

PHILADELPHIA FIGHT

Subdivision Name

Philadelphia FIGHT Jonathan Lax Treatment Center

Type

HRSA-Funded Health Center

340B ID

CHC26634-00

Entity Address

1233 Locust Street Floor 5, Suite 500 and Floor 4, Suite 400
Philadelphia, PA 19107-5453

Grant Number

H80CS26634

Participating Start Date

4/1/2014

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

COORDINATED CARE NETWORK PHARMACY

Pharmacy Address

249 S 13TH ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

4/1/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

JANE SHULL, EXECUTIVE DIRECTOR
(215) 985-4448 Ext: 102

Contract Pharmacy Representative

Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300

Signed By Date

4/1/2020

340B Drug Pricing Program Database