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CCN AMERICA, LP
STD33169 ALIVE and WELL COMMUNITY PARTNERS
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Covered Entity Details
Entity Name
ALIVE and WELL COMMUNITY PARTNERS
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33169
Entity Address
18425 N.W. 2ND AVENUE
5TH FLOOR
PH-7
MIAMI, FL 33169
Grant Number
NH25PS005131
Participating Start Date
1/1/2020
Last Recertification Date
5/25/2024
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
4/15/2021
Contract Begin Date
5/13/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/29/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Taylor, CFO/OPERATIONS OFFICER
(800) 434-1366 Ext: 1000
Contract Pharmacy Representative
Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300
Signed By Date
4/15/2021
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