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COORDINATED CARE NETWORK
HV00583 MARY WASHINGTON HEALTHCARE
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Covered Entity Details
Entity Name
MARY WASHINGTON HEALTHCARE
Subdivision Name
WELLNESS PROGRAM
Type
Ryan White Part C
340B ID
HV00583
Entity Address
1101 SAM PERRY BLVD
307
FREDERICKSBURG, VA 22401
Grant Number
H76HA00583
Participating Start Date
7/19/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK
Pharmacy Address
COORDINATED CARE NETWORK
300 PENN CENTER BLVD STE 405
PITTSBURGH, PA 15235-5511
Pharmacy Comments
5/9/11 UPDATED ADDR (WAS SUITE 505)
Contract Details
Approval Date
5/26/2011
Contract Begin Date
5/26/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
5/2/2011
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