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COORDINATED CARE NETWORK PHARMACY
RWI07501 Well of Hope Community Development Corporation Inc
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Covered Entity Details
Entity Name
Well of Hope Community Development Corporation Inc
Subdivision Name
Type
Ryan White Part A
340B ID
RWI07501
Entity Address
207 Broadway
Paterson, NJ 07501
Grant Number
H89HA49835
Participating Start Date
1/1/2018
Last Recertification Date
2/24/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
268 MARTIN LUTHER KING JR. BLVD.
NEWARK, NJ 07102
Pharmacy Comments
Contract Details
Approval Date
4/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Jerome King, Executive Director
(973) 523-0700
Contract Pharmacy Representative
Lou Montefiori, VP Sales & Marketing
(412) 303-1604
Signed By Date
4/5/2017
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