Contract Pharmacy Details

CHALLENGE CARE PHARMACY
STD891042 John Phoenix APRN, PLLC

Covered Entity Details

Entity Name

John Phoenix APRN, PLLC

Subdivision Name

Huntridge Family Clinic

Type

Sexually Transmitted Diseases

340B ID

STD891042

Entity Address

1820 E Sahara Ave
sUITE 201
Las Vegas, NV 89104

Grant Number

5 NH25PS005179-02-00

Participating Start Date

4/1/2020

Last Recertification Date

5/5/2021

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

CHALLENGE CARE PHARMACY

Pharmacy Address

CHALLENGE CARE PHARMACY LLC
6105 BEVERLYHILL ST STE 200
HOUSTON, TX 77057

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

7/1/2022
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