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COORDINATED CARE NETWORK PHARMACY
CHC00071-01 COVENANT HOUSE INC
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Covered Entity Details
Entity Name
COVENANT HOUSE INC
Subdivision Name
Covenant House Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC00071-01
Entity Address
8125-27 Stenton Avenue
Philadelphia, PA UDFND
Grant Number
H80CS00071
Participating Start Date
1/1/2025
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
249 S 13TH ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susan Stukes, Chief Executive Officer
(215) 844-1020 Ext: 219
Contract Pharmacy Representative
Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300
Signed By Date
10/2/2024
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