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LIFE TREE PHARMACY
FP199770 Connections Community Support Programs, Inc.
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Covered Entity Details
Entity Name
Connections Community Support Programs, Inc.
Subdivision Name
Smyrna
Type
Family Planning (Title X only)
340B ID
FP199770
Entity Address
320 N. High Street Ext.
Smyrna, DE 19977
Grant Number
FPHPA006418
Participating Start Date
1/1/2021
Last Recertification Date
5/3/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
LIFE TREE PHARMACY
Pharmacy Address
5 BLUE HERON DRIVE
COLLEGEVILLE, PA 19426
Pharmacy Comments
Contract Details
Approval Date
11/23/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
William Northey, President and CEO
(302) 416-0716
Contract Pharmacy Representative
Life Tree Pharmacy
Mark Taglianetti, CEO
(310) 489-6640
Signed By Date
10/8/2020
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