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PERIGON PHARMACY 360, LLC
STD16508 Central Outreach Wellness Center, LLC
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Covered Entity Details
Entity Name
Central Outreach Wellness Center, LLC
Subdivision Name
Central Outreach Wellness Center, LLC Erie
Type
Sexually Transmitted Diseases
340B ID
STD16508
Entity Address
3104 State Street
Erie, PA 16508
Grant Number
NH25PS005144
Participating Start Date
1/1/2021
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
PERIGON PHARMACY 360, LLC
Pharmacy Address
1120 STEVENSON MILL RD STE 200
CORAOPOLIS, PA 15108
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
7/15/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacy Lane, Owner
(412) 608-8313
Contract Pharmacy Representative
Perigon Pharmacy
Chris Antypas, President
(412) 498-9338
Signed By Date
7/14/2022
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