Covered Entity Details

STD194031 Family Service of Montgomery County, Pennsylvania (Approved) - information as of 5/3/2025 11:28:49 PM

Main Details

Name

Family Service of Montgomery County, Pennsylvania

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD194031

Grant Number

NU62PS924810

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
STD testing supplies from the PA Dept of Health, Bureau of Communicable Diseases
8/1/2024 - 7/31/2029

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/2/2025

Last Recertification Date

Notice of Funding Opportunity (NOFO) Number

PS24-0047

Contacts

Authorizing Official

Family Service of Montgomery County PA
Kelly Canally, CEO
(610) 630-2111 Ext: 232

Primary Contact

Family Service of Montgomery County PA
Taylor Hayes, Dir of Intervention and Supportive Services
(610) 630-2111 Ext: 266

Addresses

Street Address

3125 Ridge Pike
Norristown, PA 19403

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	LIFE TREE PHARMACY	5 BLUE HERON DRIVE		COLLEGEVILLE	PA	19426	05/02/2025	07/01/2025			05/02/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Canally, Kelly CEO Family Service of Montgomery County PA 6106302111-232	5/2/2025 7:11 AM
Details	340B ID	Update	New Registration		STD194031	5/2/2025 7:11 AM
Dates	Participating Approval Date	Update	New Registration		5/2/2025 7:11:08 AM	5/2/2025 7:11 AM
Details	State	Update	New Registration	Pending	Approved	5/2/2025 7:11 AM
Dates	Signed By Date	Update	New Registration		4/2/2025 3:11:34 PM	5/2/2025 7:11 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/2/2025 7:11 AM
Addresses	Main Address	Insert	New Registration		3125 Ridge Pike Norristown, PA 19403	4/2/2025 3:11 PM
Details	Nature of Support: In Kind Support Description	Insert	New Registration		STD testing supplies from the PA Dept of Health, Bureau of Communicable Diseases	4/2/2025 3:11 PM
Details	Nature Of Support	Insert	New Registration		In-Kind products or services (see note below; must have been purchased with section 318 funds)	4/2/2025 3:11 PM
Details	Nature of Support: Support Received From Date	Insert	New Registration		8/1/2024 12:00:00 AM	4/2/2025 3:11 PM
Details	Nature of Support: Support Received To Date	Insert	New Registration		7/31/2029 12:00:00 AM	4/2/2025 3:11 PM
Contacts	Authorizing Official	Insert	New Registration		Canally, Kelly CEO Family Service of Montgomery County PA 6106302111-232	4/2/2025 3:11 PM
Contacts	Primary Contact	Insert	New Registration		Hayes, Taylor Dir of Intervention and Supportive Services Family Service of Montgomery County PA 6106302111-266	4/2/2025 3:11 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 3:11 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 3:11 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 3:11 PM
Details	Grant Number	Insert	New Registration		NU62PS924810	4/2/2025 3:11 PM
Details	340B ID	Insert	New Registration			4/2/2025 3:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 3:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 3:11 PM
Details	Medicare Provider Number	Insert	New Registration			4/2/2025 3:11 PM
Details	Entity Name	Insert	New Registration		Family Service of Montgomery County, Pennsylvania	4/2/2025 3:11 PM
Details	NOFO Number	Insert	New Registration		PS24-0047	4/2/2025 3:11 PM
Details	Program Code	Insert	New Registration		STD	4/2/2025 3:11 PM
Details	Entity Subname	Insert	New Registration			4/2/2025 3:11 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 3:11 PM
Details	State	Insert	New Registration		Pending	4/2/2025 3:11 PM
Dates	Registration Date	Insert	New Registration		4/2/2025 3:11:34 PM	4/2/2025 3:11 PM
Dates	Signed By Date	Insert	New Registration			4/2/2025 3:11 PM
Dates	Start Date	Insert	New Registration			4/2/2025 3:11 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 3:11 PM
Terminations	Termination Date	Insert	New Registration			4/2/2025 3:11 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 3:11 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 3:11 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History