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CCN AMERICA, LP
RW4248241 Gateway Community Services, Inc
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Covered Entity Details
Entity Name
Gateway Community Services, Inc
Subdivision Name
Type
Ryan White Part D
340B ID
RW4248241
Entity Address
555 Stockton St.
Jacksonville, FL 32204
Grant Number
H12HA24824
Participating Start Date
7/1/2019
Last Recertification Date
2/7/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
CCN AMERICA, LP
Pharmacy Address
COORDINATED CARE NETWORK PHARMACY
1500 W CYPRESS CREEK RD STE 203
FT LAUDERDALE, FL 33309
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tina M. Bottini, Senior Asst. Dean, Research
(904) 244-9478
Contract Pharmacy Representative
Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300
Signed By Date
7/15/2020
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