Contract Pharmacy Details

COORDINATED CARE NETWORK PHARMACY
RWII18603D Caring Communities For AIDS, Inc.

Covered Entity Details

Entity Name

Caring Communities For AIDS, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII18603D

Entity Address

1101 Old Berwick Road
Bloomsburg, PA 17815

Grant Number

X07HA00021

Participating Start Date

7/1/2020

Last Recertification Date

2/16/2021

Entity Termination Date

7/1/2021

Pharmacy Details

Pharmacy Name

COORDINATED CARE NETWORK PHARMACY

Pharmacy Address

249 S 13TH ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

5/14/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Christopher Kupchik, Chief Executive Officer
(570) 899-1298

Contract Pharmacy Representative

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

Signed By Date

4/13/2020

340B Drug Pricing Program Database