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COORDINATED CARE NETWORK PHARMACY
STD19147 Mazzoni Center
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Covered Entity Details
Entity Name
Mazzoni Center
Subdivision Name
STD Services
Type
Sexually Transmitted Diseases
340B ID
STD19147
Entity Address
1348 Bainbridge Street
PHILADELPHIA, PA 19147
Grant Number
6NU62PS924545
Participating Start Date
10/1/2018
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
249 S 13TH ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alecia Manley, Executive Operating Officer
(215) 563-0652
Contract Pharmacy Representative
Coordinated Care Network
Daveid Giannangeli, VP, Business Development and Corporate Relations
(412) 349-6335
Signed By Date
1/13/2025
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