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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
10/5/2016
Contract Begin Date
10/6/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Xavier Richardson, Exc Vice President of Corporate Development
(540) 741-1512
Contract Pharmacy Representative
CCN AMERICA LP
Thomas J. Pollack, Vice President and CFO
(412) 349-6303
Signed By Date
10/5/2016
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