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COORDINATED CARE NETWORK PHARMACY
RWI19107E ActionAIDS dba Action Wellness
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Covered Entity Details
Entity Name
ActionAIDS dba Action Wellness
Subdivision Name
Casa Nueva Vida
Type
Ryan White Part A
340B ID
RWI19107E
Entity Address
2641 N. 6th Street
Philadelphia, PA 19133
Grant Number
H89HA00013
Participating Start Date
4/1/2018
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
249 S 13TH ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary E Torres, Executive Director
(215) 981-3338
Contract Pharmacy Representative
Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300
Signed By Date
7/6/2023
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