340B Drug Pricing Program Database


DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL (Active) - information as of 4/27/2025 1:46:34 AM

Main Details
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Disproportionate Share Hospital
No
DSH390174
390174


Additional Details
Active
3/1/2006
4/1/2006
3/1/2006
9/8/2024

Contacts

Jefferson Health
Walter Wyatt, VP-Finance
(215) 254-3254

Jefferson Health
Dustin Ottemiller, VP, Finance
(215) 503-5219

Addresses

111 South 11th Street
Philadelphia, PA 19107

Jefferson Center, Accounts Payable
1101 Market Street
20th Floor, Suite 2004
Philadelphia, PA 19107


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
10/30/2014 - REMOVED SHIPPING ADDRESS NOW LISTED AS CONTRACT PHARMACY, SEE HISTORY FOR DETAILS; 8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; PART 1/1/97 TO 9/30/99 AS DSH19107, TERMINATED 10/1/99, REINSTATED 4/1/0610/30/2014
8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; PART 1/1/97 TO 9/30/99 AS DSH19107, TERMINATED 10/1/99, REINSTATED 4/1/0610/20/2009
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NJ41968051215916002
DE00000665051215916002
PA100750854-00181215916002
Shipping Addresses

Methodist Hospital Pharmacy
2301 South Broad Street
Philadelphia, PA 19148

JHN Pharmacy
900 Walnut Street
Suite 130
Philadelphia, PA 19107

Thomas Jefferson University Hospital Pharmacy
111 South 11th St
Suite 2290
Philadelphia, PA 19107

Thomas Jefferson Univ Hospital Clinical Lab
1100 Walnut St
MOB Bldg Ste 801
Philadelphia, PA 19107

Thomas Jefferson University Hospital - ACP Cancer Care
3941 Commerce Ave
Willow Grove, PA 19090

Thomas Jefferson Univ Hospital Nuclear Med
132 S 10th St
8th Floor
848
Philadelphia, PA 19107

Jefferson Infusion Pharmacy
1101 Chestnut St
1200AG
Philadelphia, PA 19107-3612

Thomas Jefferson University Hospital - KoP
3500 Horizon Drive
Room 1074
King of Prussia, PA 19406

Jefferson Medical Oncology Pharmacy
925 Chestnut Street
222T
Philadelphia, PA 19107
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/21/201607/01/2016  07/11/2024
Contract DetailACCREDO HEALTH GROUP INC201 GREAT CIRCLE ROAD
NASHVILLETN3722804/21/201607/01/2016 10/12/201605/11/2017
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/21/201607/01/2016  07/11/2024
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/17/201707/01/2017 07/20/201810/12/2018
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/14/202110/20/2021  07/11/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/21/201607/01/2016 03/01/202406/10/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/21/201607/01/2016  07/11/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/21/201607/01/2016  07/11/2024
Contract DetailACCREDO HEALTH GROUP, INC.45 ROUTE 46 EAST SUITE 609
PINE BROOKNJ0705810/14/202110/20/2021  07/11/2024
Contract DetailACCREDO HEALTH GROUP, INC.11411 STRANG LINE RD STE A
LENEXAKS6621510/14/202110/20/2021  07/11/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/13/202204/01/2022  07/11/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280904/15/202507/01/2025  04/15/2025
Contract DetailALLIANCE PHARMACY COHIGHLAND AVE BLDG 1245 HIGHLAND AVE
HIGHLAND MEDICAL BLDG 		ABINGTONPA1900110/10/202401/01/2025  01/01/2025
Contract DetailAMBER ENTERPRISES, INCDBA AMBER SPECIALTY PHARMACY 323 NORRISTOWN RD STE 100
AMBLERPA19002-275707/16/201910/01/2019 02/24/202302/24/2023
Contract DetailAVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508501/16/201904/01/2019 07/15/202107/15/2021
Contract DetailBERGEN PHARMACY39 E MOUNT PLEASANT AVE
LIVINGSTONNJ0703910/15/202110/20/2021  10/20/2021
Contract DetailBERGEN PHARMACYBERGEN PHARMACY 194 CLINTON AVE
NEWARKNJ07108-280910/15/202110/20/2021  10/20/2021
Contract DetailBIOLOGICSBIOLOGICS BY MCKESSON 13000 WESTON PKWY, STE 105
CARYNC27513-225007/16/201910/01/2019 07/14/202007/15/2020
Contract DetailBIOLOGICS, INC.BIOLOGICS BY MCKESSON 11800 WESTON PARKWAY
CARYNC2751307/10/202007/10/2020  07/13/2020
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/12/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/12/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/12/202404/01/2024  04/01/2024
Contract DetailBRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410604/17/201707/01/2017 01/01/202001/16/2020
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/17/201601/01/2017  05/11/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/26/202001/01/2021  01/01/2021
Contract DetailCENTERWELL PHARMACY, INC.10737 MARKS WAY
MIRAMARFL3302507/15/202010/01/2020  10/01/2020
Contract DetailCENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506907/15/202010/01/2020  10/01/2020
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 220 EXECUTIVE DRIVE
SUITE 500 		CRANBERRY TOWNSHIPPA1606607/07/201710/01/2017 01/17/202503/31/2025
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 6 SPRING MILL DR
MALVERNPA1935507/07/201710/01/2017  10/01/2017
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 2345 WATERS DRIVE
MENDOTA HEIGHTSMN5512001/15/202504/01/2025  04/01/2025
Contract DetailCORAM HEALTHCARE CORPORATION OF GREATERDBA CORAM CVS/SPECIALTY INFUSION SERVICE 2949 ERIE BLVD EAST
SUITE 103 		SYRACUSENY1322407/07/201710/01/2017 01/17/202503/31/2025
Contract DetailCORAM HEALTHCARE/CAROLINA HOME THERAPEUT720 GRACERN ROAD SUITE 123
COLUMBIASC2921007/07/201710/01/2017 10/14/202403/31/2025
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/26/202001/01/2021  01/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/26/202001/01/2021  01/01/2021
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/26/202001/01/2021  01/01/2021
Contract DetailCYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503304/21/201607/01/2016 08/09/201708/09/2017
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503306/28/201707/01/2017  06/28/2017
Contract DetailDELAWARE CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #3042 1545 PULASKI HIGHWAY
BEARDE1970110/26/202001/01/2021  01/01/2021
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268307/14/202010/01/2020 07/12/202202/10/2023
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654101/12/202404/01/2024  04/01/2024
Contract DetailEINSTEIN APOTHECARY5501 OLD YORK RD # LEVY1 ALBERT EINSTEIN MEDICAL CTR
PHILADELPHIAPA1914110/10/202401/01/2025  01/01/2025
Contract DetailEINSTEIN AT CENTER ONE PHARMACY9880 BUSTLETON AVE STE 305
PHILADELPHIAPA19115-214410/14/202110/20/2021  10/20/2021
Contract DetailEINSTEIN LIVEWELL PHARMACY1321 W TABOR RD
PHILADELPHIAPA1914110/10/202401/01/2025  01/01/2025
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/25/201807/01/2018  04/25/2018
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/25/201807/01/2018  04/25/2018
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/25/201807/01/2018  04/25/2018
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/25/201807/01/2018  04/25/2018
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 255 PHILLIPI ROAD
COLUMBUSOH4322804/25/201807/01/2018 05/01/201905/20/2019
Contract DetailGENOA HEALTHCARE LLC3609 N BROAD ST STE P
PHILADELPHIAPA1914007/16/202108/03/2021  07/11/2024
Contract DetailGENOA HEALTHCARE LLC2600 N AMERICAN ST
PHILADELPHIAPA1913307/16/202108/03/2021  07/11/2024
Contract DetailHAPPY HARRY'S INC.DBA: WALGREENS 51 BALTIMORE PIKE
GLEN MILLSPA1934210/17/201601/01/2017  05/11/2017
Contract DetailJEFFERSON APOTHECARY  111 S 11TH ST
PHILADELPHIAPA1910704/21/201607/01/2016 05/13/201605/11/2017
Contract DetailJEFFERSON NAVY YARD PHARMACY3 CRESCENT DR FL 1
PHILADELPHIAPA19112-101601/15/202004/01/2020  04/01/2020
Contract DetailJEFFERSON PHARMACY833 CHESTNUT ST STE 125
PHILADELPHIAPA1910710/29/201410/30/2014  05/11/2017
Contract DetailJEFFERSON PHARMACY 1101 CHESTNUT1101 CHESTNUT ST STE 2500
PHILADELPHIAPA1910704/25/202407/01/2024  07/01/2024
Contract DetailJEFFERSON PHARMACY-WALNUT ST908 WALNUT ST
PHILADELPHIAPA19107-556401/17/201404/01/2014  05/11/2017
Contract DetailJEFFEX, INC.ALSO KNOWN AS JEFFERSON APOTHECARY 111 S 11TH ST STE 1850
PHILADELPHIAPA19107-482405/03/201605/12/2016  05/11/2017
Contract DetailK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906010/06/201701/01/2018  10/06/2017
Contract DetailKENNEDY UNIVERSITY HOSP - STRATFORD18 E LAUREL RD PHARMACY DEPT.
STRATFORDNJ08084-132704/15/202407/01/2024  07/01/2024
Contract DetailMEDILINK RX CARE, LLC1120 WHITE HORSE RD UNIT 112
VOORHEESNJ0804307/12/202410/01/2024  10/01/2024
Contract DetailMEDILINK RXCARE HAMMONTON, LLC44 S. WHITE HORSE PIKE
HAMMONTONNJ0803707/12/202410/01/2024  10/01/2024
Contract DetailMETHODIST HOSPITAL APOTHECARY  2301 SOUTH BROAD STREET
PHILADELPHIAPA1914804/21/201605/12/2016  05/11/2017
Contract DetailMETHODIST HOSPITAL APOTHECARY2301 S BROAD ST
PHILADELPHIAPA1914805/04/201607/01/2016 05/13/201605/11/2017
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00398 2506 DELAWARE AVE
NORTH WILDWOODNJ0826010/26/202001/01/2021  01/01/2021
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00228 25 EAST RED BANK AVENUE
WOODBURYNJ0809601/15/202504/01/2025  04/01/2025
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00362 307 EGG HARBOR RD
SEWELLNJ0808001/15/202504/01/2025  04/01/2025
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00855 1060 NORTH DELSEA DRIVE BLDG. 3
GLASSBORONJ0802801/15/202504/01/2025  04/01/2025
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01165 1098 MANTUA PIKE
WENONAHNJ0809001/15/202504/01/2025  04/01/2025
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03759 121 CENTER SQUARE RD
SWEDESBORONJ0808504/15/202507/01/2025  04/15/2025
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06035 1099 RTE. 33 HAMILTON SQUARE
HAMILTONNJ0869004/15/202507/01/2025  04/15/2025
Contract DetailNEW JERSEY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06877 6103 W. JERSEY AVE.
EGG HARBOR TWPNJ0823404/15/202507/01/2025  04/15/2025
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/17/201707/01/2017 07/15/202107/15/2021
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/01/202410/01/2024  10/01/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260107/01/202410/01/2024  10/01/2024
Contract DetailOPTUM INFUSION SERVICES 201, INC.5700 DOT COM CT STE 1030
OVIEDOFL32765-340007/16/202108/03/2021  07/11/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135107/16/202108/03/2021  07/11/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC4000 CHEMICAL RD STE 100
PLYMOUTH MEETINGPA1946207/16/202108/03/2021  07/11/2024
Contract DetailOPTUM INFUSION SERVICES 500, INC.4900 RIVERGRADE RD STE E120
IRWINDALECA91706-141907/16/202108/03/2021 08/02/202210/13/2022
Contract DetailOPTUM INFUSION SERVICES 550, LLC7167 E. KEMPER RD.
CINCINNATIOH4524907/16/202108/03/2021  07/11/2024
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705810/26/202001/01/2021  07/11/2024
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276507/01/202410/01/2024  10/01/2024
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/11/202207/12/2022  07/11/2024
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520407/01/202410/01/2024  10/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/17/201707/01/2017  07/11/2024
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/17/201707/01/2017  07/11/2024
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265507/14/202010/01/2020  07/11/2024
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970507/15/202010/01/2020  07/11/2024
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/17/201707/01/2017  07/11/2024
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/15/202010/01/2020  07/11/2024
Contract DetailOPTUM PHARMACY 800, INC.3016 GUADALUPE ST STE A
AUSTINTX78705-286101/16/201904/01/2019 01/01/202302/10/2023
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/15/202107/01/2021  07/11/2024
Contract DetailOPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161807/14/202010/01/2020 07/15/202106/02/2022
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660801/15/202004/01/2020 05/27/202206/02/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/15/202004/01/2020  07/11/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01064 1826-30 CHESTNUT STREET
PHILADELPHIAPA1910310/17/201601/01/2017  05/11/2017
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01913 1405 SOUTH 10TH STREET
PHILADELPHIAPA1914710/17/201601/01/2017  05/11/2017
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02077 1901 WEST OREGON AVENUE
PHILADELPHIAPA1914510/17/201601/01/2017  05/11/2017
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02398 3300-10 SOUTH BROAD STREET
PHILADELPHIAPA1914510/17/201601/01/2017  05/11/2017
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02866 1046 MARKET ST.
PHILADELPHIAPA1910710/17/201601/01/2017  05/11/2017
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02255 2640 E. CUMBERLAND ST.
PHILADELPHIAPA1912501/12/201804/01/2018  01/12/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08984 6701 RIDGE AVE.
PHILADELPHIAPA1912807/12/201810/01/2018  10/01/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02972 922-938 N. BROAD ST.
PHILADELPHIAPA1913007/12/201810/01/2018 02/12/202103/17/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02159 2320-26 FAIRMOUNT AVENUE
PHILADELPHIAPA1913007/12/201810/01/2018  10/01/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02583 421 SOUTH SECOND ST.
PHILADELPHIAPA1914707/12/201810/01/2018 02/09/202302/10/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02157 1001 WASHINGTON AVENUE #99
PHILADELPHIAPA1914707/12/201810/01/2018 02/28/202204/28/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02266 6900 LINDBERGH BLVD.
PHILADELPHIAPA1914207/12/201810/01/2018  10/01/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00371 6501 HARBISON AVENUE
PHILADELPHIAPA1914907/12/201810/01/2018  10/01/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16775 1 MIFFLIN ST
PHILADELPHIAPA1914807/12/201810/01/2018  10/01/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01196 7700 GERMANTOWN AVENUE
PHILADELPHIAPA1911807/12/201810/01/2018  10/01/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05867 401 SPRING GARDEN ST.
PHILADELPHIAPA1912307/12/201810/01/2018  10/01/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01545 1500 SPRUCE STREET
PHILADELPHIAPA1910204/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02114 6562-68 HAVERFORD AVENUE
PHILADELPHIAPA1915104/14/202007/01/2020 10/01/202110/14/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00379 1424-26 CHESTNUT STREET
PHILADELPHIAPA1910204/14/202007/01/2020 02/15/202202/10/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10090 2132 SOUTH STREET
PHILADELPHIAPA1914604/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02121 6601 NORTH BROAD STREET
PHILADELPHIAPA1912604/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10526 259 MARKET ST
PHILADELPHIAPA1910604/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY # 10459 1919 MARKET ST. SUITE 150
PHILADELPHIAPA1910304/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02074 4133 G ST.
PHILADELPHIAPA1912404/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00826 1051 SOUTH ST
SOUTH STREET S/C 		PHILADELPHIAPA1914704/14/202007/01/2020 05/23/202304/15/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00771 6150 N 5TH STREET
PHILADELPHIAPA1912004/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02755 4314 LOCUST STREET
PHILADELPHIAPA1910404/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02408 802 N LANSDOWNE AVE
DREXEL HILLPA1902604/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02120 6344 STENTON AVENUE
PHILADELPHIAPA1913804/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02704 4849 MARKET ST.
PHILADELPHIAPA1913904/14/202007/01/2020  07/01/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02688 55 PARK AVE.
COLLEGEVILLEPA1942610/26/202001/01/2021  01/01/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07184 7720 BUSTLETON AVE
PHILADELPHIAPA1915210/26/202001/01/2021 05/22/202403/31/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07132 3015 E. LINCOLN HIGHWAY
THORNDALEPA1937210/26/202001/01/2021  01/01/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10399 3373 E LINCOLN HWY
PARKESBURGPA1936510/26/202001/01/2021  01/01/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02811 4400 CASTOR AVE.
PHILADELPHIAPA1912410/26/202001/01/2021 01/13/202201/13/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00675 159 N. MACDADE BLVD.
GLENOLDENPA1903610/26/202001/01/2021  01/01/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02156 5843-45 RISING SUN AVENUE
PHILADELPHIAPA1912010/26/202001/01/2021 04/15/202404/15/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00987 548 DOYLESTOWN RD.
LANSDALEPA1944610/26/202001/01/2021  01/01/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02689 7350 OXFORD AVE.
PHILADELPHIAPA1911110/26/202001/01/2021 01/01/202302/10/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00919 2622 JENKINTOWN ROAD
GLENSIDEPA1903810/26/202001/01/2021  01/01/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY # 11170 1201 WALNUT ST
PHILADELPHIAPA1910704/15/202407/01/2024  07/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02222 7520 CITY LINE AVE.
PHILADELPHIAPA1915101/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02783 518 PORT ROYAL AVENUE
PHILADELPHIAPA1912801/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03142 119 E. BALTIMORE AVE.
LANSDOWNEPA1905001/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5081 101 W CITY AVENUE
BALA CYNWYDPA1900401/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5346 260 ROCK HILL RD.
BALA CYNWYDPA1900401/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #11356 3401 ARAMINGO AVENUE
PHILADELPHIAPA1913401/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11371 1717 NORTH 12TH STREET, UNIT F
PHILADELPHIAPA1912201/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 17207 4000 MONUMENT RD
PHILADELPHIAPA1913101/15/202504/01/2025  04/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01193 835 OLD YORK ROAD
JENKINTOWNPA1904604/15/202507/01/2025  04/15/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02530 2870 MORELAND ROAD
WILLOW GROVEPA1909004/15/202507/01/2025  04/15/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03799 929 DEKALB PIKE
BLUE BELLPA1942204/15/202507/01/2025  04/15/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY # 10896 629 WEST LANCASTER AVE
WAYNEPA1908704/15/202507/01/2025  04/15/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY # 11136 314 SOUTH 5TH STREET
PHILADELPHIAPA1910604/15/202507/01/2025  04/15/2025
Contract DetailPERFORMSPECIALTY, LLC2416 LAKE ORANGE DR. STE 190
ORLANDOFL3283710/13/202210/24/2022  10/24/2022
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/13/201710/01/2017 11/15/202301/08/2024
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/17/201601/01/2017  05/11/2017
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY # 02553 1117 WALNUT ST.
PHILADELPHIAPA1910710/26/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/26/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/26/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/26/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.CVS/PHARMACY #48637 2700 NORTHEAST EXPY NE STE B800
BUILDING B 		ATLANTAGA3034504/15/202507/01/2025  04/15/2025
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/12/202404/01/2024  04/01/2024
Contract DetailRite Aid 6811701 Delran Pkwy
DelranNJ0807504/15/202507/01/2025  04/15/2025
Contract DetailRITE AID OF NEW JERSEY, INC.RITE AID #1917 236 SOUTH DELSEA DRIVE
CLAYTONNJ0831201/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF NEW JERSEY, INC.RITE AID #1860 490 HURFVILLE-CROSS KEYS
SEWELLNJ0808001/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1936 2017-2023 SOUTH BROAD ST.
PHILADELPHIAPA1914804/21/201607/01/2016  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3876 1500 W. MOYAMENSING AVENUE
PHILADELPHIAPA1914504/21/201607/01/2016  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1766 10 SNYDER AVENUE
PHILADELPHIAPA1914804/21/201607/01/2016  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3770 1000-1008 MARKET STREET
PHILADELPHIAPA1910704/21/201607/01/2016 05/02/202209/07/2022
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3325 1443 SOUTH 7TH STREET
PHILADELPHIAPA1914704/21/201607/01/2016  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3227 3000-02 REED STREET
PHILADELPHIAPA1914604/21/201607/01/2016 10/04/202301/08/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3434 1924 FAIRMOUNT AVENUE
PHILADELPHIAPA1913004/21/201607/01/2016  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913910/17/201601/01/2017  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2698 339 SPRING GARDEN STREET
PHILADELPHIAPA1912310/17/201601/01/2017 03/02/202204/28/2022
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912110/17/201601/01/2017  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3783 810 S BROAD ST
PHILADELPHIAPA19146-221710/17/201601/01/2017 11/28/202303/04/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3825 801 SOUTH 9TH STREET
PHILADELPHIAPA1914710/17/201601/01/2017  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3959 2301 WALNUT STREET
PHILADELPHIAPA1910310/17/201601/01/2017 07/28/202203/20/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #479 7615 LINDBERGH BOULEVARD
PHILADELPHIAPA1915310/17/201601/01/2017  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1127 2131-59 NORTH BROAD STREET
PHILADELPHIAPA1912210/17/201601/01/2017  05/11/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #4611 5040 CITY LINE AVENUE
PHILADELPHIAPA1913104/25/201807/01/2018  04/25/2018
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3457 136 NORTH 63RD STREET
PHILADELPHIAPA1913904/25/201807/01/2018 10/12/202302/28/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #4932 260 WEST LEHIGH AVENUE #80
PHILADELPHIAPA1913304/25/201807/01/2018  04/25/2018
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1320 640 MONTGOMERY AVENUE
NARBERTHPA1907204/25/201807/01/2018  04/25/2018
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #174 1628-36 CHESTNUT STREET
PHILADELPHIAPA1910304/25/201807/01/2018 01/11/202403/04/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1941 7401 OGONTZ AVENUE
PHILADELPHIAPA1913804/25/201807/01/2018  04/25/2018
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #857 169 WEST LANCASTER AVENUE
ARDMOREPA1900301/15/202004/01/2020 10/05/202302/28/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3637 6363 FRANKFORD AVENUE
PHILADELPHIAPA1913501/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3461 5301 CHEW AVENUE
PHILADELPHIAPA1913801/15/202004/01/2020 09/05/202301/08/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3251 3601 MIDVALE AVENUE
PHILADELPHIAPA1912901/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1767 2801 W. DAUPHIN STREET
PHILADELPHIAPA1913201/15/202004/01/2020 09/25/202301/08/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1365 215 SOUTH BROAD STREET
PHILADELPHIAPA1910701/15/202004/01/2020 09/21/202103/20/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #552 6401 OXFORD AVENUE
PHILADELPHIAPA1911101/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #06777 1900 ARCH ST
PHILADELPHIAPA19103-150001/15/202004/01/2020 05/16/202209/07/2022
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3801 704-20 EAST PASSYUNK AVENUE
PHILADELPHIAPA1914701/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3225 2201 WEST ALLEGHENY AVE.
PHILADELPHIAPA1913201/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2793 1201-43 WEST GIRARD AVE.
PHILADELPHIAPA1912301/15/202004/01/2020 07/15/202107/15/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #242 730-32 MARKET STREET
PHILADELPHIAPA1910601/15/202004/01/2020 05/09/202209/07/2022
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2578 2121 W LEHIGH AVENUE STE5
PHILADELPHIAPA1913201/15/202004/01/2020 12/12/202303/04/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914301/15/202004/01/2020  04/01/2020
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2587 3260 NORTH BROAD STREET
PHILADELPHIAPA1914001/15/202004/01/2020 12/17/202303/04/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/12/202404/01/2024  04/01/2024
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/12/202404/01/2024  04/01/2024
Contract DetailTHRIFT DRUG, INC.RITE AID #11140 2512 ISLAND AVENUE
PHILADELPHIAPA1915310/17/201601/01/2017 03/23/202209/07/2022
Contract DetailTHRIFT DRUG, INC.RITE AID #11133 2000 HAMILTON STREET
PHILADELPHIAPA1913001/15/202004/01/2020 05/18/202305/18/2023
Contract DetailTORRESDALE PHARMACY3998 RED LION RD STE 105
PHILADELPHIAPA1911410/15/202401/01/2025  01/01/2025
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-17423501 ROUTE 42
TURNERSVILLENJ0801201/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-1869150 ROUTE 70 EAST
MARLTONNJ0805301/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-2068180 LEVITTOWN PARKWAY
LEVITTOWNPA1905501/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-21084620 BLACK HORSE PIKE
MAYS LANDINGNJ0833001/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-21411675 S CHRISTOPHER COLUMBUS BLVD
PHILADELPHIAPA1914801/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-225455 S. WHITE HORSE PIKE
HAMMONTONNJ0803701/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-24451515 BETHLEHEM PIKE HATFIELD
HILLTOWNPA1944001/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-2535500 TERRY RICH BLVD.
SAINT CLAIRPA1797001/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-26504301 BYBERRY RD, UNIT A
PHILADELPHIAPA1915401/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-33373159 ROUTE 9 SOUTH
RIO GRANDENJ0824201/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-34222000 CLEMENTS BRIDGE RD SUITE 100
DEPTFORDNJ0809601/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-3541516 SCHOOLHOUSE RD
KENNETT SQUAREPA1934801/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-35642101 BLAIR MILL RD
WILLOW GROVEPA1909001/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-356553 WEST GERMANTOWN PIKE
EAST NORRISTOWNPA1940101/15/202004/01/2020 12/11/202012/11/2020
Contract DetailWAL-MART PHARMACY 10-37741840 S BLACK HORSE PIKE
WILLIAMSTOWNNJ0809401/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-44561 COOPERTOWN BLVD
SOMERDALENJ0808301/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-5047130 BLACKHORSE PIKE
AUDUBONNJ0810601/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-51034600 E ROOSEVELT BLVD BLDG G
PHILADELPHIAPA1912401/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-51309745 ROOSEVELT BLVD A
PHILADELPHIA (BU)PA1911401/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-52291000 EASTON RD STE 200
WYNCOTEPA1909501/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-5340500 ROUTE 38
CHERRY HILLNJ0800201/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-53841130 HIGHWAY 77
BRIDGETONNJ0830201/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-54361251 CENTERVILLE ROAD
WILMINGTON,DE1980801/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-5476820 COOPER ST
DEPTFORDNJ0809601/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-549550 NORTH MACDADE BLVD.
GLENOLDENPA1903601/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-5881400 S STATE ROAD
SPRINGFIELDPA1906401/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-58912200 WHEATSHEAF LANE
PHILADELPHIAPA1913701/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/15/202004/01/2020  04/01/2020
Contract DetailWALGREEN EASTERN CO INCDBA: WALGREENS # 04115 4201 N BROAD ST
PHILADELPHIAPA1914004/14/202007/01/2020 01/30/202503/31/2025
Contract DetailWALGREEN EASTERN CO. INC.DBA:WALGREENS #15336 1 SOUTH BROAD STREET
PHILADELPHIAPA1910710/17/201601/01/2017 02/28/202204/28/2022
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 1101 LOCUST ST.
PHILADELPHIAPA1910704/21/201607/01/2016 01/29/202503/31/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03791 2014-24 S BROAD ST
PHILADELPHIAPA1914504/21/201607/01/2016 11/12/202411/12/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05984 8 HADDON AVENUE
HADDON TOWNSHIPNJ0810804/21/201607/01/2016  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06367 1809 E ALLEGHENY AVE
PHILADELPHIAPA1913404/21/201607/01/2016 03/02/202305/04/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07543 2310 W OREGON AVE
PHILADELPHIAPA19145-412204/21/201607/01/2016  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16519 1334 BAINBRIDGE ST
PHILADELPHIAPA1914704/21/201607/01/2016  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #11780 2655 SOUTH TENTH ST.
PHILADELPHIAPA1914804/21/201607/01/2016 03/01/202305/04/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 1800 SOUTH ST.
PHILADELPHIAPA1914604/21/201607/01/2016  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #15316 1227 LOCUST ST
PHILADELPHIAPA1910710/17/201601/01/2017  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07336 1617 JOHN F KENNEDY BLVD LBBY W8
PHILADELPHIAPA1910310/17/201601/01/2017  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #11595 245 N BROAD ST STE 1
PHILADELPHIAPA1910710/17/201601/01/2017  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04487 3620 CONCORD RD
ASTONPA1901410/17/201601/01/2017  05/11/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02014 8500 NEW FALLS ROAD
LEVITTOWNPA1905404/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #10156 20 W. KINGS HWY.
MOUNT EPHRAIMNJ08059-130304/14/202007/01/2020 03/26/202503/31/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06894 2727 W CHELTENHAM AVENUE
WYNCOTEPA1909504/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04429 150 N MACDADE BLVD.
GLENOLDENPA1903604/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 7201 CASTOR AVE.
PHILADELPHIAPA1914904/14/202007/01/2020 01/23/202503/31/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 300 N. 63RD ST.
PHILADELPHIAPA1913904/14/202007/01/2020 01/21/202503/31/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS #11897 504 KINGS HWY. NORTH
CHERRY HILLNJ0803404/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #10324 500 EGG HARBOR RD.
SEWELLNJ08080-233604/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01106 1456 BETHLEHEM PIKE
FLOURTOWNPA1903104/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06929 1819 ROUTE 70 WEST
CHERRY HILLNJ0800204/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05836 1408 DELSEA DRIVE
WOODBURYNJ0809604/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04926 7001 FRANKFORD AVE
PHILADELPHIAPA1913504/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07225 1 YORKTOWN PLAZA
ELKINS PARKPA1902704/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03663 4098 EDGEMONT AVE.
BROOKHAVENPA1901504/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 8828 FRANKFORD AVE.
PHILADELPHIAPA1913604/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05522 1607 BRIDGE ST
PHILADELPHIAPA1912404/14/202007/01/2020 11/15/202301/08/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 112 W CHELTEN AVE
PHILADELPHIAPA1914404/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07121 404 ROUTE 73 SOUTH
MARLTONNJ08053-204804/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03569 4001 KENSINGTON AVE.
PHILADELPHIAPA1912404/14/202007/01/2020 08/07/202008/24/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07590 2 E. STREET RD
FEASTERVILLE TREVOSEPA19053-760304/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #12695 1601 NAAMANS RD
WILMINGTONDE1981004/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07544 10000 BUSTLETON AVE
PHILADELPHIAPA19116-374804/14/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06319 2435 STREET ROAD
BENSALEMPA1902004/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07224 119 E DEKALB PIKE
KING OF PRUSSIAPA1940604/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16070 1600 HADDON AVE STE 100
CAMDENNJ0810304/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS SPECIALTY PHARMACY #16532 1201 N MARKET ST STE 101
WILMINGTONDE1980104/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21169 541 HAMILTON ST
ALLENTOWNPA1810104/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21251 3550 MARKET ST STE 103
PHILADELPHIAPA1910404/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.100 E LANCASTER AVE STE 12
WYNNEWOODPA19096-340007/15/202410/01/2024 04/21/202504/21/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03764 690 2ND STREET PIKE
SOUTHAMPTONPA1896607/15/202410/01/2024 05/22/202504/15/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04356 10 YORK ROAD
WARMINSTERPA1897407/15/202410/01/2024  10/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06837 699 W GERMANTOWN PIKE
EAST NORRITONPA19403-423307/15/202410/01/2024  10/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 30 W. RIDGE PIKE
LIMERICKPA1946810/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07366 3300 DEKALB PIKE
EAST NORRITONPA1940110/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07014 2803 W RIDGE PIKE
NORRISTOWNPA19403-153410/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 494 NUTT RD.
PHOENIXVILLEPA19460-335410/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #12048 221 DELSEA DR N
GLASSBORONJ0802810/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05986 590 CROSS KEYS RD
SICKLERVILLENJ0808110/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #10490 1601 KEARSLEY RD.
SICKLERVILLENJ0808110/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01531 625 N BLACK HORSE PIKE
BLACKWOODNJ0801210/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03549 630 CHEWS LANDING
LINDENWOLDNJ0802110/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04059 100 N WHITE HORSE PIKE
MAGNOLIANJ0804910/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06174 13 N BLACK HORSE PIKE
WILLIAMSTOWNNJ08094-140210/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06741 180 BRIDGETON PIKE
MANTUANJ08051-156910/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS PHARMACY #16239 1 HAMILTON HEALTH PLACE
SUITE S158 		HAMILTONNJ0869010/07/202401/01/2025  01/01/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16560 532 FEDERAL ST
CAMDENNJ0810310/07/202401/01/2025  01/01/2025
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/21/201607/01/2016 10/01/202110/14/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/21/201607/01/2016  05/11/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/21/201607/01/2016  05/11/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/21/201607/01/2016  05/11/2017
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275605/04/202307/01/2023  07/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/12/202404/01/2024  04/01/2024
Contract DetailWALNUT HOME THERAPEUTICS3500 HORIZON DRIVE
KING OF PRUSSIAPA1940607/11/201410/01/2014  05/11/2017
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH390174AChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMETHODIST HOSPITAL DIVISION, TJUH2301 SOUTH BROAD STREETPHILADELPHIAPATerminated
DSH390174AAChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Mammography2301 South Broad StreetPhiladelphiaPAActive
DSH390174ABChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Radiology - Special Studies2301 South Broad StreetPhiladelphiaPAActive
DSH390174ACChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Anesthesia2301 South Broad StreetPhiladelphiaPAActive
DSH390174ADChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Recovery Room2301 South Broad StreetPhiladelphiaPAActive
DSH390174AEChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Operating Room2301 South Broad StreetPhiladelphiaPAActive
DSH390174AFChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Urodynamics2301 South Broad StreetPhiladelphiaPATerminated
DSH390174AGChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Emergency Room900 Walnut StreetPhiladelphiaPAActive
DSH390174AHChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Radiology - MRI900 Walnut StreetPhiladelphiaPAActive
DSH390174AJChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Radiology - CT900 Walnut StreetPhiladelphiaPAActive
DSH390174AKChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Brain Tumor Center900 Walnut StreetPhiladelphiaPAActive
DSH390174ALChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Gamma Knife Suite900 Walnut StreetPhiladelphiaPAActive
DSH390174AMChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Interventional Radiology900 Walnut StreetPhiladelphiaPAActive
DSH390174ANChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Radiology900 Walnut StreetPhiladelphiaPAActive
DSH390174APChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Anesthesia900 Walnut StreetPhiladelphiaPAActive
DSH390174AQChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Recovery Room900 Walnut StreetPhiladelphiaPAActive
DSH390174ARChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Operating Room900 Walnut StreetPhiladelphiaPAActive
DSH390174ASChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALTHOMAS JEFFERSON UNIVERSITY HOSPITALS O/P Ultrasound909 WALNUT STREETPHILADELPHIAPAActive
DSH390174ATChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALPulmonary Function Lab1101 Chestnut StreetPhiladelphiaPAActive
DSH390174AUChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMammography- Breast Imaging / Mammography1101 Chestnut StreetPhiladelphiaPAActive
DSH390174AVChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALCLINICAL OFFICE BUILDING / ALS Clinic1101 Chestnut StreetPhiladelphiaPAActive
DSH390174AWChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Medical Oncology MHD1300 Wolf StreetPhiladelphiaPAActive
DSH390174AXChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / GI/Hepatology MHD1300 Wolf StreetPhiladelphiaPAActive
DSH390174AYChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Internal Med. JIMA33 South 9th StreetPhiladelphiaPAActive
DSH390174AZChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Endocrinology211 South 9th StreetPhiladelphiaPAActive
DSH390174BChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Hospital Ambulatory Practice33 South 9th StreetPhiladelphiaPAActive
DSH390174BAChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Rheumatology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BBChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Neuroscience1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BCChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Neurology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BDChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Headache900 Walnut StPhiladelphiaPAActive
DSH390174BEChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Multiple Sclerosis1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BFChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Family Medicine33 South 9th StreetPhiladelphiaPAActive
DSH390174BGChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic / Medical Oncology CC1101 Chestnut StPhiladelphiaPAActive
DSH390174BHChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJeff Fit Rehab2144 Cecil B. Moore AvePhiladelphiaPAActive
DSH390174BJChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJeff Comprehensive Concussion Center4050 South 26th StreetphiladelphiaPAActive
DSH390174BKChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic- Cardiology CC - Cardiology925 Chestnut StreetPhiladelphiaPAActive
DSH390174BLChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic- Urology CC - Urology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BMChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic- Nephrology CC - Nephrology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BNChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic- Pulmonary CC - Pulmonary1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BPChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic- OBGYN CC - OBGYN833 Chestnut StreetPhiladelphiaPAActive
DSH390174BQChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic-Internal Med Brd - Internal Medicine2301 S Broad St, Suite 205PhiladelphiaPAActive
DSH390174BRChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Cardio Pulmonary - MHD Cardio Pulmonary2301 South Broad StreetPhiladelphiaPAActive
DSH390174BSChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALTJUH Echocardiography - Echocardiology Walnut Towers900 Walnut StreetPhiladelphiaPAActive
DSH390174BTChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Radiology - JHN Neuro Non-Invasive Lab900 Walnut StreetPhiladelphiaPAActive
DSH390174BUChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Ultrasound - MHD Ultrasound2301 South Broad StreetPhiladelphiaPAActive
DSH390174BVChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Hemodialysis - MHD Hemodialysis2301 South Broad StreetPhiladelphiaPAActive
DSH390174BWChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Hematology - Hematology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BXChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Otolaryngology - Otolaryngology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174BYChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - MHD Endo - Endocrinology2301 S. Broad StreetPhiladelphiaPAActive
DSH390174BZChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Dermatology - Dermatology33 South 9th StreetPhiladelphiaPAActive
DSH390174CChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Neurology Infusion Center900 Walnut StreetPhiladelphiaPAActive
DSH390174CAChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Navy Yard-Pain Management - Pain Management3 Crescent DrivePhiladelphiaPAActive
DSH390174CBChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Navy Yard-Internal Med - Internal Medicine3 Crescent DrivePhiladelphiaPAActive
DSH390174CCChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Navy Yard-Family Med - Family Medicine3 Crescent DrivePhiladelphiaPAActive
DSH390174CDChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Navy Yard-Neurosurgery - Neurosurgery3 Crescent DrivePhiladelphiaPAActive
DSH390174CEChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Navy Yard-OB/GYN - OB/GYN3 Crescent DrivePhiladelphiaPAActive
DSH390174CFChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Navy Yard-Neurology - Neurology3 Crescent DrivePhiladelphiaPAActive
DSH390174CGChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Navy Yard-PM&R - PM&R3 Crescent DrivePhiladelphiaPAActive
DSH390174CHChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB - Neurology Meadowbrook - Neurology3501 Masons Mill RoadHuntingdon ValleyPAActive
DSH390174CJChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALInfusion Center Meadowbrook - Neurology3501 Masons Mill Rd, Suite 504Huntingdon ValleyPAActive
DSH390174CKChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALTHOMAS JEFFERSON UNIVERSITY HOSPITA - ACP Physical Therapy3941 Commerce AvenueWillow GrovePAActive
DSH390174CLChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALTJUH Infusion Center - ACP Cancer Care3941 Commerce AveWillow GrovePAActive
DSH390174CMChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALTJUH Asplundh - Interventional Radiology ACP3941 Commerce AveWillow GrovePAActive
DSH390174CNChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALTJUH Asplundh - ACP Rehab-Speech Therapy3941 Commerce AveWillow GrovePAActive
DSH390174CPChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALTHOMAS JEFFERSON UNIVERSITY HOSPITA - Asplundh Oncology Clinic3941 Commerce AvenueWillow GrovePAActive
DSH390174CQChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Cardio - Cardiology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174CRChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic-Alg 211 - Asthma and Allergy1101 Chestnut StreetPhiladelphiaPAActive
DSH390174CSChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic-Pul CC - Pulmonary1101 Chestnut StreetPhiladelphiaPAActive
DSH390174CTChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN SPU - Short Procedure Unit900 WalnutPhiladelphiaPAActive
DSH390174CUChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD OP Rehab - PT/OT/Speech2301 South Broad StreetPhiladelphiaPAActive
DSH390174CVChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Dialysis - Nephrology - Acute Dialysis900 WalnutPhiladelphiaPAActive
DSH390174CWChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN Neurodiagnostics - Electrodiagnostic - Emg900 WalnutPhiladelphiaPAActive
DSH390174CXChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic - Endo CC - Endocrinology33 S 9th StPhiladelphiaPAActive
DSH390174CYChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHonickman Radiology - - X-Ray1101 Chestnut StreetPhiladelphiaPAActive
DSH390174CZChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHonickman Radiology - - Ultrasound1101 Chestnut StreetPhiladelphiaPAActive
DSH390174DChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Oncology Infusion Center1101 Chestnut StreetPhiladelphiaPAActive
DSH390174DAChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Rehab CC - - PT/OT/Speech25 S 9th StPhiladelphiaPAActive
DSH390174DBChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Honickman - - General Surgery1101 Chestnut StreetPhiladelphiaPAActive
DSH390174DCChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Colorectal Surgery225 E City AvePhiladelphiaPAActive
DSH390174DDChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Endocrinology225 E City AvePhiladelphiaPAActive
DSH390174DEChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Weight Management225 E City AvePhiladelphiaPAActive
DSH390174DFChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Cardiology225 E City AvePhiladelphiaPAActive
DSH390174DGChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Rheumatology225 E City AvePhiladelphiaPAActive
DSH390174DHChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Gastroenterology225 E City AvePhiladelphiaPAActive
DSH390174DJChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Internal Medicine225 E City AvePhiladelphiaPAActive
DSH390174DKChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Pulmonary225 E City AvePhiladelphiaPAActive
DSH390174DLChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Bala - - Nephrology225 E City AvePhiladelphiaPAActive
DSH390174DMChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHonickman - Neurodiagnostics - Electrodiagnostic - Emg1101 Chestnut StreetPhiladelphiaPAActive
DSH390174DNChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHonickman Vas Ctr - - Vascular and Cardiac Surg1101 Chestnut StreetPhiladelphiaPAActive
DSH390174DPChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic GI/Hep CC - - GI/Hepatology1101 Chestnut StreetPhiladelphiaPAActive
DSH390174DQChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALHB Clinic Inf - - Infectious Disease1101 Chestnut StreetPhiladelphiaPAActive
DSH390174EChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Infusion Center at Methodist1300 Wolf StreetPhiladelphiaPAActive
DSH390174FChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJHN EKG900 Walnut StreetPhiladelphiaPAActive
DSH390174GChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Rheumatology Infusion Center211 South 9th StreetPhiladelphiaPAActive
DSH390174HChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Vascular Center at Methodist1300 Wolf StreetPhiladelphiaPAActive
DSH390174JChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALO/P MRI Facility909 Walnut StreetPhiladelphiaPAActive
DSH390174KChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALRadiation Oncology - Riddle Memorial1078 West Baltimore PikeMediaPAActive
DSH390174LChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALJefferson Surgery Center1101 Chestnut StreetPhiladelphiaPAActive
DSH390174MChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALCardiac Imaging Center1101 Chestnut StreetPhiladelphiaPAActive
DSH390174NChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALUrologic Diagnostic Center1101 Chestnut StreetPhiladelphiaPAActive
DSH390174PChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALSickle Cell OBV Unit833 Chestnut StreetPhiladelphiaPATerminated
DSH390174QChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Observation Unit2301 South Broad StreetPhiladelphiaPAActive
DSH390174RChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Emegency Room2301 South Broad StreetPhiladelphiaPAActive
DSH390174SChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Short Procedure Unit2301 South Broad StreetPhiladelphiaPAActive
DSH390174TChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD EEG2301 South Broad StreetPhiladelphiaPAActive
DSH390174UChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Gastroenterology2301 South Broad StreetPhiladelphiaPAActive
DSH390174VChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Radiology - MRI2301 South Broad StreetPhiladelphiaPAActive
DSH390174WChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Radiology - CT2301 South Broad StreetPhiladelphiaPAActive
DSH390174XChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Nuclear Medicine2301 South Broad StreetPhiladelphiaPAActive
DSH390174YChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Radiation Oncology2301 South Broad StreetPhiladelphiaPATerminated
DSH390174ZChildDSHTHOMAS JEFFERSON UNIVERSITY HOSPITALMHD Radiology2301 South Broad StreetPhiladelphiaPAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateProfile Change RequestWyatt, Walter VP-Finance Albert Einstein Medical Center 2152543254Wyatt, Walter VP-Finance Jefferson Health 21525432541/30/2025 1:33 PM
ContactsAuthorizing OfficialUpdateChange RequestNathans, Andrew Vice president Finance, TJUH Inc. TJUH Inc 2159556599Wyatt, Walter VP-Finance Albert Einstein Medical Center 21525432541/30/2025 11:11 AM
DetailsLast Recertification DateUpdateRecertification8/26/2023 2:38:00 PM9/8/2024 12:21:28 AM9/8/2024 12:21 AM
ContactsPrimary ContactUpdateProfile Change RequestOttemiller, Dustin VP, Finance Thomas Jefferson University Hospitals, Inc. 2155035219Ottemiller, Dustin VP, Finance Jefferson Health 21550352199/3/2024 11:17 AM
AddressesShipping AddressUpdateChange RequestThomas Jefferson University Hospital - KoP 3500Horizon Drive Room 1074 King of Prussia, PA 19406Thomas Jefferson University Hospital - KoP 3500 Horizon Drive Room 1074 King of Prussia, PA 194066/20/2024 7:01 AM
AddressesShipping AddressInsertChange Request Jefferson Medical Oncology Pharmacy 925 Chestnut Street 222T Philadelphia, PA 191076/12/2024 6:55 AM
AddressesShipping AddressInsertChange Request Thomas Jefferson University Hospital - KoP 3500Horizon Drive Room 1074 King of Prussia, PA 194066/11/2024 11:55 AM
AddressesShipping AddressInsertChange Request Jefferson Infusion Pharmacy 1101 Chestnut St 1200AG Philadelphia, PA 19107-36125/17/2024 9:53 AM
ContactsPrimary ContactUpdateChange RequestSwift, Brian G. Chief Pharmacy Officer Thomas Jefferson University Hospital 2159556736Ottemiller, Dustin VP, Finance Thomas Jefferson University Hospitals, Inc. 21550352195/17/2024 9:53 AM
AddressesShipping AddressInsertChange Request Thomas Jefferson Univ Hospital Nuclear Med 132 S 10th St 8th Floor 848 Philadelphia, PA 191075/3/2024 7:50 AM
AddressesBilling AddressInsertRecertification Jefferson Center, Accounts Payable 1101 Market Street 20th Floor, Suite 2004 Philadelphia, PA 191078/26/2023 2:38 PM
DetailsLast Recertification DateUpdateRecertification9/7/2022 4:27:48 PM8/26/2023 2:38:00 PM8/26/2023 2:38 PM
AddressesShipping AddressInsertChange Request Thomas Jefferson University Hospital - ACP Cancer Care 3941 Commerce Ave Willow Grove, PA 190906/15/2023 12:42 PM
AddressesShipping AddressInsertChange Request Thomas Jefferson Univ Hospital Clinical Lab 1100 Walnut St MOB Bldg Ste 801 Philadelphia, PA 191073/17/2023 10:08 AM
DetailsLast Recertification DateUpdateRecertification8/23/2021 10:17:17 AM9/7/2022 4:27:48 PM9/7/2022 4:27 PM
DetailsLast Recertification DateUpdateRecertification8/24/2020 10:59:29 AM8/23/2021 10:17:17 AM8/23/2021 10:17 AM
AddressesShipping AddressInsertRecertification Thomas Jefferson University Hospital Pharmacy 111 South 11th St Suite 2290 Philadelphia, PA 191078/24/2020 10:59 AM
Medicaid BillingNPI: NumberInsertRecertification 12159160028/24/2020 10:59 AM
Medicaid BillingNPI: StateInsertRecertification DE8/24/2020 10:59 AM
Medicaid BillingNPI: NumberInsertRecertification 12159160028/24/2020 10:59 AM
Medicaid BillingNPI: StateInsertRecertification NJ8/24/2020 10:59 AM
Medicaid BillingNPI: StateUpdateRecertification PA8/24/2020 10:59 AM
DetailsLast Recertification DateUpdateRecertification8/26/2019 2:39:40 PM8/24/2020 10:59:29 AM8/24/2020 10:59 AM
ContactsAuthorizing OfficialUpdateAO Change RequestLUBARSKY, NEIL G. SR VP FOR FINANCE Thomas Jefferson Univ Hospital 2159559993Nathans, Andrew Vice president Finance, TJUH Inc. TJUH Inc 21595565993/27/2020 11:17 AM
DetailsLast Recertification DateUpdateRecertification8/24/2018 11:22:49 AM8/26/2019 2:39:40 PM8/26/2019 2:39 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/24/2018 11:22 AM
Medicaid BillingMedicaid: NumberInsertRecertification 41968058/24/2018 11:22 AM
Medicaid BillingMedicaid: StateInsertRecertification NJ8/24/2018 11:22 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/24/2018 11:22 AM
Medicaid BillingMedicaid: NumberInsertRecertification 00000665058/24/2018 11:22 AM
Medicaid BillingMedicaid: StateInsertRecertification DE8/24/2018 11:22 AM
DetailsLast Recertification DateUpdateRecertification11/30/2017 11:32:31 AM8/24/2018 11:22:49 AM8/24/2018 11:22 AM
DetailsLast Recertification DateUpdateRecertification8/29/2016 12:00:00 AM11/30/2017 11:32:31 AM11/30/2017 11:32 AM
ContactsPrimary ContactUpdateChange RequestSwift, Brian Chief Pharmacy Officer Thomas Jefferson University Hospital 2159556736Swift, Brian G. Chief Pharmacy Officer Thomas Jefferson University Hospital 215955673610/23/2017 3:37 PM
ContactsAuthorizing OfficialUpdate LUBARSKY, NEIL G. SR VP FOR FINANCE 2159559993LUBARSKY, NEIL G. SR VP FOR FINANCE Thomas Jefferson Univ Hospital 215955999310/6/2017 12:27 PM
ContactsPrimary ContactUpdate Swift, Brian Chief Pharmacy Officer 2159556736Swift, Brian Chief Pharmacy Officer Thomas Jefferson University Hospital 215955673610/5/2017 1:25 PM
ContactsAuthorizing OfficialInsert  LUBARSKY, NEIL G. SR VP FOR FINANCE 21595599938/9/2017 1:10 PM
ContactsPrimary ContactInsert  Swift, Brian Chief Pharmacy Officer 21595567365/11/2017 5:31 PM
AddressesMain AddressInsert   111 SOUTH 11TH STREET PHILADELPHIA, PA 191075/11/2017 5:31 PM
AddressesShipping AddressInsert  Methodist Hospital Pharmacy 2301 South Broad Street Philadelphia, PA 191485/11/2017 5:31 PM
AddressesShipping AddressInsert  JHN Pharmacy 900 Walnut Street Suite 130 Philadelphia, PA 191075/11/2017 5:31 PM
DetailsLast Recertification DateUpdate 9/1/2015 12:00:00 AM8/29/2016 12:00:00 AM9/2/2016 11:09 AM
Medicaid BillingMedicaid: NumberUpdate 100750854100750854-00189/1/2015 1:26 PM
Medicaid BillingNPI: NumberUpdate 170097692512159160029/1/2015 1:26 PM
DetailsLast Recertification DateUpdate 8/27/2014 12:00:00 AM9/1/2015 12:00:00 AM9/1/2015 1:26 PM
DetailsComments PublicInsert  10/30/2014 - REMOVED SHIPPING ADDRESS NOW LISTED AS CONTRACT PHARMACY, SEE HISTORY FOR DETAILS; 8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; PART 1/1/97 TO 9/30/99 AS DSH19107, TERMINATED 10/1/99, REINSTATED 4/1/0610/30/2014 11:01 AM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/27/2014 7:37 AM
Medicaid BillingMedicaid: NumberUpdate 10075085400111007508548/27/2014 7:37 AM
Medicaid BillingNPI: NumberInsert  17009769258/27/2014 7:37 AM
DetailsLast Recertification DateUpdate 8/27/2013 12:00:00 AM8/27/2014 12:00:00 AM8/27/2014 7:37 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/27/2013 12:00:00 AM8/27/2013 8:11 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/18/2012 12:30 PM
DetailsLast Recertification DateInsert   10/20/2009 1:05 PM
DetailsGrant NumberInsert   10/20/2009 1:05 PM
Details340B IDInsert  DSH39017410/20/2009 1:05 PM
DetailsIs Authorizing Official EHB DataInsert   10/20/2009 1:05 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/20/2009 1:05 PM
DetailsMedicare Provider NumberInsert  39017410/20/2009 1:05 PM
DetailsEntity NameInsert  THOMAS JEFFERSON UNIVERSITY HOSPITAL10/20/2009 1:05 PM
DetailsProgram CodeInsert  DSH10/20/2009 1:05 PM
DetailsEntity SubnameInsert   10/20/2009 1:05 PM
DatesParticipating Approval DateInsert  3/1/2006 12:00:00 AM10/20/2009 1:05 PM
DetailsStateInsert  Active10/20/2009 1:05 PM
DatesRegistration DateInsert  3/1/2006 12:00:00 AM10/20/2009 1:05 PM
DatesSigned By DateInsert  2/17/2006 12:00:00 AM10/20/2009 1:05 PM
DatesStart DateInsert  4/1/2006 12:00:00 AM10/20/2009 1:05 PM
TerminationsTermination CommentsInsert   10/20/2009 1:05 PM
TerminationsTermination DateInsert   10/20/2009 1:05 PM
TerminationsTermination Effective DateInsert   10/20/2009 1:05 PM
TerminationsTermination ReasonInsert   10/20/2009 1:05 PM
DetailsComments PublicInsert  8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; PART 1/1/97 TO 9/30/99 AS DSH19107, TERMINATED 10/1/99, REINSTATED 4/1/0610/20/2009 1:05 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True3/1/2006 8:16 AM
Medicaid BillingMedicaid: NumberInsert  10075085400113/1/2006 8:16 AM
Medicaid BillingMedicaid: StateInsert  PA3/1/2006 8:16 AM