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PHYSICIAN'S RX PHARMACY, LLC
RWII93401B Access Support Network
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Covered Entity Details
Entity Name
Access Support Network
Subdivision Name
Monterey
Type
Ryan White Part B
340B ID
RWII93401B
Entity Address
Montage Medical Group Ryan Ranch Campus
2 Upper Ragsdale Dr. Building A
Monterey, CA 93940
Grant Number
X07HA10954
Participating Start Date
5/8/2023
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PHYSICIAN'S RX PHARMACY, LLC
Pharmacy Address
PHYSICIANS RX PHARMACY, LLC
9701 APOLLO DRIVE
#400
LARGO, MD 20774
Pharmacy Comments
Contract Details
Approval Date
5/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Kilburn, Executive Director
(805) 781-3660 Ext: 212
Contract Pharmacy Representative
Physicians Rx Pharmacy of Clinton
Chris Wakefield, Manager
(412) 357-5163
Signed By Date
5/4/2023
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