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COORDINATED CARE NETWORK PHARMACY
FQHCLA463A Mazzoni Center
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Covered Entity Details
Entity Name
Mazzoni Center
Subdivision Name
Bainbridge
Type
Health Center Program Look-Alike
340B ID
FQHCLA463A
Entity Address
1348 Bainbridge St
Philadelphia, PA 19147-1810
Grant Number
LALCS52965
Participating Start Date
4/1/2024
Last Recertification Date
2/17/2025
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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