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CCN AMERICA, LP
STD333055 The Poverello Center Inc.
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Covered Entity Details
Entity Name
The Poverello Center Inc.
Subdivision Name
EXTRA Care Clinic
Type
Sexually Transmitted Diseases
340B ID
STD333055
Entity Address
2056 N Dixie Hwy
Wilton Manors, FL 33305
Grant Number
NH25PS005131
Participating Start Date
2/9/2022
Last Recertification Date
5/10/2024
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
10/24/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas S Pietrogallo, CEO
(954) 561-3663 Ext: 101
Contract Pharmacy Representative
The Poverello Center Inc.
Jose Castillo, Operations Manager
(954) 561-3663 Ext: 115
Signed By Date
10/24/2022
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