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MAXOR NATIONAL PHARMACY SERVICES, LLC
RWII02657 Provincetown AIDS Support Group d.b.a. AIDS Support Group of Cape Cod
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Covered Entity Details
Entity Name
Provincetown AIDS Support Group d.b.a. AIDS Support Group of Cape Cod
Subdivision Name
Type
Ryan White Part B
340B ID
RWII02657
Entity Address
96-98 Bradford Street
Provincetown, MA 02657
Grant Number
X07HA00082
Participating Start Date
4/1/2015
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
MAXOR NATIONAL PHARMACY SERVICES, LLC
Pharmacy Address
DBA BRIGHTPOINT PHARMACY
1543 INWOOD AVE FL 3
BRONX, NY 10452
Pharmacy Comments
Contract Details
Approval Date
5/8/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul E Goddu, CFO
(508) 487-9445
Contract Pharmacy Representative
Maxor
Lorrie Carr, 340B Specialist
(708) 910-8758
Signed By Date
5/8/2023
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