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PERIGON PHARMACY 360, LLC
STD18017 Novus Adult Care Services
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Covered Entity Details
Entity Name
Novus Adult Care Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD18017
Entity Address
1565 Linden Street
Bethlehem, PA 18017
Grant Number
NH25PS005144
Participating Start Date
4/1/2016
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
PERIGON PHARMACY 360, LLC
Pharmacy Address
1120 STEVENSON MILL RD STE 200
CORAOPOLIS, PA 15108
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allen C Smith, Owner
(610) 867-5365
Contract Pharmacy Representative
Perigon Pharmacy
Chris Antypas, President
(412) 498-9338
Signed By Date
4/12/2024
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