Contract Pharmacy Details

AHSSHC
CHC26514-00 TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Covered Entity Details

Entity Name

TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Subdivision Name

TAPM Pediatrics at Wendover

Type

HRSA-Funded Health Center

340B ID

CHC26514-00

Entity Address

1046 E Wendover Ave
Greensboro, NC 27405-6712

Grant Number

H80CS26514

Participating Start Date

1/1/2015

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

AHSSHC

Pharmacy Address

EXPEDIEN RX PHARMACY
5050 WESLEY RD STE 120
APOPKA, FL 32712

Pharmacy Comments

Contract Details

Approval Date

4/6/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/2/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michelle Lewis, CEO
(336) 355-9715

Contract Pharmacy Representative

Agape
Trenia Yielding, Executive Director
(407) 357-2601

Signed By Date

4/6/2017

340B Drug Pricing Program Database