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LIFE TREE PHARMACY
STD197113 Conexio Care, Inc
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Covered Entity Details
Entity Name
Conexio Care, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD197113
Entity Address
3106 Drummond Plaza
Newark, DE 19711
Grant Number
NH25PS005156-03-00
Participating Start Date
11/15/2021
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
LIFE TREE PHARMACY
Pharmacy Address
5 BLUE HERON DRIVE
COLLEGEVILLE, PA 19426
Pharmacy Comments
Contract Details
Approval Date
11/9/2021
Contract Begin Date
11/15/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angie Logan, VP of Policy and Program Development
(484) 650-1937
Contract Pharmacy Representative
Life Tree Pharmacy
Mark Taglianetti, CEO
(310) 489-6640
Signed By Date
10/6/2021
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