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COORDINATED CARE NETWORK PHARMACY
STD07304 Hyacinth AIDS Foundation
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Covered Entity Details
Entity Name
Hyacinth AIDS Foundation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD07304
Entity Address
48 Fairview Avenue
Jersey City, NJ 07304
Grant Number
NH25PS005174-05-06
Participating Start Date
1/1/2019
Last Recertification Date
5/17/2024
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
268 MARTIN LUTHER KING JR. BLVD.
NEWARK, NJ 07102
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathy Ahearn-O'Brien, Executive Director
(732) 246-0204
Contract Pharmacy Representative
CCN Pharmacy
Lou Montefiori, VP, Sales and Marketing
(412) 303-1604
Signed By Date
4/15/2021
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