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LIFE TREE PHARMACY
STD152141 Merakey Pennsylvania
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Covered Entity Details
Entity Name
Merakey Pennsylvania
Subdivision Name
106 Cedarwood
Type
Sexually Transmitted Diseases
340B ID
STD152141
Entity Address
106 Cedarwood Circle
russelton, PA 15214
Grant Number
NU62PS924544
Participating Start Date
4/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
LIFE TREE PHARMACY
Pharmacy Address
1996 EWINGS MILL RD
CORAOPOLIS, PA 15108-3310
Pharmacy Comments
Contract Details
Approval Date
4/2/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph S Martz, CEO
(215) 341-9395
Contract Pharmacy Representative
Life Tree Pharmacy
Mark Taglianetti, CEO
(310) 489-6640
Signed By Date
4/2/2024
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