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CCN AMERICA, LP
RWII32114 Outreach Community Care Network
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Covered Entity Details
Entity Name
Outreach Community Care Network
Subdivision Name
Type
Ryan White Part B
340B ID
RWII32114
Entity Address
240 N Frederick Avenue
Daytona Beach, FL 32114
Grant Number
XO7HA00057
Participating Start Date
4/1/2013
Last Recertification Date
2/14/2025
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
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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