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ALTRUIX
STD191491 Courage Medicine Health Center, Inc
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Covered Entity Details
Entity Name
Courage Medicine Health Center, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD191491
Entity Address
7198 Castor Ave
200
Philadelphia, PA 19149
Grant Number
NH25PS005233-01-00
Participating Start Date
1/1/2024
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
ALTRUIX
Pharmacy Address
3800 HORIZON BLVD STE 103
TREVOSE, PA 19053
Pharmacy Comments
Contract Details
Approval Date
11/27/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Carson Moore, Executive Director
(215) 510-5199
Contract Pharmacy Representative
Altriux
Yeardly Green, Executive Vice President
(410) 868-9852
Signed By Date
11/20/2023
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