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COORDINATED CARE NETWORK PHARMACY
STD15212 Allegheny Clinic
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Covered Entity Details
Entity Name
Allegheny Clinic
Subdivision Name
The Positive Health Clinic-Mobile Van
Type
Sexually Transmitted Diseases
340B ID
STD15212
Entity Address
30 Isabella Street
Suite 111
Pittsburgh, PA 15212
Grant Number
5 NH25PS005144-04-00
Participating Start Date
1/1/2023
Last Recertification Date
5/8/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
100 N CAMERON ST. STE 201
HARRISBURG, PA 17101
Pharmacy Comments
Contract Details
Approval Date
11/29/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Donald Mark Whiting, President Allegheny Clinic
(412) 330-2497
Contract Pharmacy Representative
CCN
Fredrick J. Grasser, Senior Manager
(412) 349-6308
Signed By Date
10/17/2022
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