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CCN AMERICA, LP
STD321141 Outreach Community Care Network
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Covered Entity Details
Entity Name
Outreach Community Care Network
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD321141
Entity Address
240 N. Frederick Avenue
Daytona Beach, FL 32114
Grant Number
1H25PS75095001550
Participating Start Date
1/1/2020
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
CCN AMERICA, LP
Pharmacy Address
COORDINATED CARE NETWORK PHARMACY
1500 W CYPRESS CREEK RD STE 203
FT LAUDERDALE, FL 33309
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joseph B Huynh, Clinical Director
(386) 255-5569 Ext: 216
Contract Pharmacy Representative
Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300
Signed By Date
10/13/2017
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