Contract Pharmacy Details

EPIC PHARMACY
RWI891041A John Phoenix APRN, PLLC

Covered Entity Details

Entity Name

John Phoenix APRN, PLLC

Subdivision Name

Type

Ryan White Part A

340B ID

RWI891041A

Entity Address

The Gay and Lesbian Center of Southern Nevada
401 S. Maryland Parkway
Las Vegas, NV 89101

Grant Number

H89HA06900

Participating Start Date

4/1/2020

Last Recertification Date

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

EPIC PHARMACY

Pharmacy Address

EPIC PHARMACY LLC
2249 NW 39TH ST
OKLAHOMA CITY, OK 73112

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

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John Phoenix, Chief Clinical Officer
(702) 979-1111

Contract Pharmacy Representative

Elite Analytics Group, Inc
Rex Green, CEO
(469) 899-2293

Signed By Date

7/15/2020

340B Drug Pricing Program Database