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LIFE TREE PHARMACY
STD194031 Family Service of Montgomery County, Pennsylvania
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Covered Entity Details
Entity Name
Family Service of Montgomery County, Pennsylvania
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD194031
Entity Address
3125 Ridge Pike
Norristown, PA 19403
Grant Number
NU62PS924810
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
LIFE TREE PHARMACY
Pharmacy Address
5 BLUE HERON DRIVE
COLLEGEVILLE, PA 19426
Pharmacy Comments
Contract Details
Approval Date
5/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Canally, CEO
(610) 630-2111 Ext: 232
Contract Pharmacy Representative
Life Tree Pharmacy
Ed Scott, Pharmacy Manager
(484) 432-0734
Signed By Date
4/2/2025
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