Covered Entity Details

CHC26634-02 PHILADELPHIA FIGHT (Active) - information as of 6/24/2025 3:09:32 AM

Main Details

Name

PHILADELPHIA FIGHT

Subdivision Name

John Bell Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-015234

340B ID

CHC26634-02

Grant Number

H80CS26634

Additional Details

Current Program Status

Active

Registration Date

7/13/2015

Participating Start Date

10/1/2015

Participating Approval Date

7/20/2015

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

Philadelphia FIGHT
Jose A. Benitez, CEO
(215) 985-4448 Ext: 102

Primary Contact

Philadelphia FIGHT
Greg Landistratis, Director of Revenue Cycle
(215) 985-4448

Addresses

Street Address

1207 Chestnut St,
Philadelphia, PA 19107-4131

Billing Address

Philadelphia FIGHT
1233 Locust St., 3rd Fl
Philadelphia, PA 19107

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites 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?
Yes

State	Medicaid Number	NPI Number
PA	1007472220013	1487082608

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	COORDINATED CARE NETWORK PHARMACY	249 S 13TH ST		PHILADELPHIA	PA	19107	10/20/2023	01/01/2024		01/01/2024
Contract Detail	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	04/18/2016	07/01/2016		04/18/2016
Contract Detail	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	10/12/2018	01/01/2019	12/30/2022	09/07/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15316	1227 LOCUST ST	PHILADELPHIA	PA	19107	07/20/2015	10/01/2015		07/20/2015

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC26634-00	Active	BPS-H80-013140	PHILADELPHIA FIGHT	Philadelphia FIGHT Jonathan Lax Treatment Center	1233 Locust Street Floor 5, Suite 500 and Floor 4, Suite 400		Philadelphia	PA
CHC26634-01	Active	BPS-H80-021967	PHILADELPHIA FIGHT	FIGHT Pediatric and Adolescent Medicine YHEP Clinic	1207 Chestnut St, Fl 5		Philadelphia	PA
CHC26634-02	Active	BPS-H80-015234	PHILADELPHIA FIGHT	John Bell Clinic	1207 Chestnut St,		Philadelphia	PA
CHC26634-03	Terminated	BPS-H80-021967	Philadelphia Fight	FIGHT Pediatric and Adolescent Medicine YHEP Clinic	1207 Chestnut St. 5th Floor		Philadelphia	PA
CHC26634-04	Active	BPS-H80-019757	Philadelphia FIGHT	Dental Clinic	1207 Chestnut Street Fl 4 and 5		Philadelphia	PA
CHC26634-05	Active	BPS-H80-021186	Philadelphia Fight	Broad Street Ministry	315 S Broad St		Philadelphia	PA
CHC26634-06	Terminated	BPS-H80-022293	Philadelphia Fight	Clinica Bienestar	2913 Kensington Ave. Philadelphia PA 1st floor and basement		Philadelphia	PA
CHC26634-07	Active	BPS-H80-022344	Philadelphia Fight	Diana Baldwin Clinic	1211 Chestnut St.	Suite 605	Philadelphia	PA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC26634-00	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	07/01/2024
CHC26634-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	11/15/2022	12/31/2023
CHC26634-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	11/15/2022	12/31/2023
CHC26634-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	11/15/2022	12/31/2023
CHC26634-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	11/15/2022	12/31/2023
CHC26634-00	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	11/15/2022	12/31/2023
CHC26634-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	11/15/2022
CHC26634-00	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	11/15/2022	08/09/2023
CHC26634-00	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2024
CHC26634-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2024
CHC26634-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2024
CHC26634-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2024
CHC26634-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2024
CHC26634-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2024
CHC26634-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2024
CHC26634-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2024
CHC26634-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2024
CHC26634-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2024
CHC26634-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2024
CHC26634-00	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2020
CHC26634-00	COORDINATED CARE NETWORK PHARMACY	100 N CAMERON ST. STE 201		HARRISBURG	PA	17101	04/01/2020
CHC26634-00	COORDINATED CARE NETWORK PHARMACY	249 S 13TH ST		PHILADELPHIA	PA	19107	04/01/2020
CHC26634-04	COORDINATED CARE NETWORK PHARMACY	249 S 13TH ST		PHILADELPHIA	PA	19107	01/01/2024
CHC26634-01	COORDINATED CARE NETWORK PHARMACY	249 S 13TH ST		PHILADELPHIA	PA	19107	01/01/2024
CHC26634-02	COORDINATED CARE NETWORK PHARMACY	249 S 13TH ST		PHILADELPHIA	PA	19107	01/01/2024
CHC26634-05	COORDINATED CARE NETWORK PHARMACY	249 S 13TH ST		PHILADELPHIA	PA	19107	01/01/2024
CHC26634-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2025
CHC26634-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2025
CHC26634-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2024
CHC26634-00	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	07/01/2017	01/01/2018
CHC26634-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2017
CHC26634-00	ECKERD CORPORATION	RITE AID #11124	4055-89 MARKET STREET	PHILADELPHIA	PA	19104	07/01/2019
CHC26634-00	ECKERD CORPORATION	RITE AID #10484	1070 NORTH PEARL STREET	BRIDGETON	NJ	08302	07/01/2022	09/19/2024
CHC26634-00	ECKERD CORPORATION	RITE AID #11135	6327-43 TORRESDALE AVENUE	PHILADELPHIA	PA	19135	11/15/2022	10/11/2023
CHC26634-00	ECKERD CORPORATION	RITE AID #11136	1334 WINDRIM AVENUE	PHILADELPHIA	PA	19141	07/01/2025
CHC26634-00	ECKERD CORPORATION	RITE AID #11125	7418 OXFORD AVE	PHILADELPHIA	PA	19111	07/01/2025
CHC26634-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	11/15/2022
CHC26634-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	11/15/2022	12/31/2023
CHC26634-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	11/15/2022
CHC26634-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	11/15/2022	12/31/2023
CHC26634-00	GENOA HEALTHCARE LLC	3609 N BROAD ST STE P		PHILADELPHIA	PA	19140	11/15/2022	06/06/2025
CHC26634-00	HAPPY HARRY'S INC.	DBA:WALGREENS	2608 NAAMANS CREEK ROAD	UPPER CHICHESTER	PA	19061	07/01/2014	07/27/2020
CHC26634-00	HOLMESBURG PHARMACY	8039 FRANKFORD AVE.		PHILA	PA	19136	07/01/2024
CHC26634-00	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2016
CHC26634-01	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2016
CHC26634-02	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2016
CHC26634-00	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	07/01/2024
CHC26634-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01522	22565 THREE NOTCH RD.	CALIFORNIA	MD	20619	04/01/2024
CHC26634-00	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02231	1300 WOODLANE ROAD	EASTAMPTON	NJ	08060	04/01/2024
CHC26634-00	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07842	180 GREENTREE RD.	MARLTON	NJ	08053	04/01/2024
CHC26634-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	11/15/2022
CHC26634-00	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	11/15/2022	12/31/2023
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11170	1201 WALNUT ST	PHILADELPHIA	PA	19107	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02755	4314 LOCUST STREET	PHILADELPHIA	PA	19104	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04007	3925 WALNUT ST.	PHILADELPHIA	PA	19104	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02159	2320-26 FAIRMOUNT AVENUE	PHILADELPHIA	PA	19130	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10090	2132 SOUTH STREET	PHILADELPHIA	PA	19146	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02397	8525 FRANKFORD AVENUE	PHILADELPHIA	PA	19136	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02866	1046 MARKET ST.	PHILADELPHIA	PA	19107	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02704	4849 MARKET ST.	PHILADELPHIA	PA	19139	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01064	1826-30 CHESTNUT STREET	PHILADELPHIA	PA	19103	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01196	7700 GERMANTOWN AVENUE	PHILADELPHIA	PA	19118	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02255	2640 E. CUMBERLAND ST.	PHILADELPHIA	PA	19125	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02554	4214 WOODBOURNE RD	LEVITTOWN	PA	19057	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01913	1405 SOUTH 10TH STREET	PHILADELPHIA	PA	19147	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02077	1901 WEST OREGON AVENUE	PHILADELPHIA	PA	19145	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00371	6501 HARBISON AVENUE	PHILADELPHIA	PA	19149	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 17696	7162 RIDGE AVENUE	PHILADELPHIA	PA	19128	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01193	835 OLD YORK ROAD	JENKINTOWN	PA	19046	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06043	302 W. BRIDGE STREET	NEW HOPE	PA	18938	04/01/2024
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02398	3300-10 SOUTH BROAD STREET	PHILADELPHIA	PA	19145	01/01/2025
CHC26634-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS/PHARMACY #11371	1717 NORTH 12TH STREET, UNIT F	PHILADELPHIA	PA	19122	04/01/2025
CHC26634-00	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	07/01/2024
CHC26634-06	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/01/2019	10/01/2020
CHC26634-00	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/01/2019	12/30/2022
CHC26634-00	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/01/2019	07/01/2020
CHC26634-02	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/01/2019	12/30/2022
CHC26634-03	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/01/2019	10/01/2021
CHC26634-05	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/01/2019	12/30/2022
CHC26634-04	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/01/2019	12/30/2022
CHC26634-00	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/01/2017	10/01/2022
CHC26634-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2024
CHC26634-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2024
CHC26634-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2024
CHC26634-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY # 02553	1117 WALNUT ST.	PHILADELPHIA	PA	19107	04/01/2025
CHC26634-00	RITE AID OF NEW JERSEY, INC.	RITE AID #1860	490 HURFVILLE-CROSS KEYS	SEWELL	NJ	08080	04/01/2021	09/19/2024
CHC26634-00	RITE AID OF NEW JERSEY, INC.	RITE AID #236	1360 BLACKWOOD CLEMENTON RD.	CLEMENTON	NJ	08021	11/15/2022
CHC26634-00	RITE AID OF NEW JERSEY, INC.	RITE AID #135	217 SUNSET ROAD	WILLINGBORO	NJ	08046	01/01/2025
CHC26634-00	RITE AID OF NEW JERSEY, INC.	RITE AID #1321	4902 WESTFIELD AVENUE	PENNSAUKEN	NJ	08110	07/01/2025
CHC26634-00	RITE AID OF NEW JERSEY, INC.	RITE AID #1860	490 HURFVILLE-CROSS KEYS	SEWELL	NJ	08080	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #242	730-32 MARKET STREET	PHILADELPHIA	PA	19106	07/01/2019	05/09/2022
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2604	6101 NORTH BROAD STREET	PHILADELPHIA	PA	19141	07/01/2019	04/01/2022
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4932	260 WEST LEHIGH AVENUE #80	PHILADELPHIA	PA	19133	07/01/2019	01/10/2021
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3325	1443 SOUTH 7TH STREET	PHILADELPHIA	PA	19147	07/01/2019
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3434	1924 FAIRMOUNT AVENUE	PHILADELPHIA	PA	19130	07/01/2019
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2790	1406 CECIL B MOORE AVE	PHILADELPHIA	PA	19121	07/01/2019	04/01/2022
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1127	2131-59 NORTH BROAD STREET	PHILADELPHIA	PA	19122	07/01/2019	04/01/2022
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3783	810 S BROAD ST	PHILADELPHIA	PA	19146-2217	07/01/2019	01/10/2021
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1936	2017-2023 SOUTH BROAD ST.	PHILADELPHIA	PA	19148	04/01/2021
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2587	3260 NORTH BROAD STREET	PHILADELPHIA	PA	19140	11/15/2022
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #679	123 SOUTH 69TH STREET	UPPER DARBY	PA	19082	11/15/2022	09/19/2024
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #552	6401 OXFORD AVENUE	PHILADELPHIA	PA	19111	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1299	2503-05 WELSH ROAD	PHILADELPHIA	PA	19114	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2451	5214-30 BALTIMORE AVENUE	PHILADELPHIA	PA	19143	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3389	2674 EGYPT ROAD	AUDUBON	PA	19403	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #679	123 SOUTH 69TH STREET	UPPER DARBY	PA	19082	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4611	5040 CITY LINE AVENUE	PHILADELPHIA	PA	19131	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3225	2201 WEST ALLEGHENY AVE.	PHILADELPHIA	PA	19132	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #856	762 CHESTER PIKE	PROSPECT PARK	PA	19076	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3394	4530 NORTH 5TH STREET	PHILADELPHIA	PA	19140	07/01/2025
CHC26634-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1941	7401 OGONTZ AVENUE	PHILADELPHIA	PA	19138	07/01/2025
CHC26634-00	SUN RAY DRUG, LLC	142 S 52ND STREET		PHILADELPHIA	PA	19139	07/01/2024
CHC26634-00	SUNRAY DRUGS 60TH STREET	128 SOUTH 60TH ST		PHILADELPHIA	PA	19139	07/01/2024
CHC26634-00	SUNRAY DRUGS KENSINGTON & ALLEGHENY	825 E ALLEGHENY AVE		PHILADELPHIA	PA	19134	07/01/2024
CHC26634-00	SUNRAY DRUGS PROGRESS PLAZA	1501 N BROAD ST STE 9		PHILADELPHIA	PA	19122	07/01/2024
CHC26634-00	SUNRAY DRUGS SPECIALTY	142 S 52ND ST	SUITE 201	PHILADELPHIA	PA	19139	07/01/2024
CHC26634-00	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06412	5521 CHARLOTTE AVENUE	NASHVILLE	TN	37209	04/01/2024
CHC26634-00	THRIFT DRUG, INC.	RITE AID #11131	2545 ARAMINGO AVENUE.	PHILADELPHIA	PA	19125	04/01/2021
CHC26634-00	THRIFT DRUG, INC.	RITE AID #11153	1535 W CHESTER PIKE	WEST CHESTER	PA	19382-7753	01/01/2025
CHC26634-00	THRIFT DRUG, INC.	RITE AID #11126	9910 FRANKFORD AVENUE SUITE 250	PHILADELPHIA	PA	19114	01/01/2025
CHC26634-00	THRIFT DRUG, INC.	RITE AID #11122	284 EAST LANCASTER AVENUE	WYNNEWOOD	PA	19096	07/01/2025
CHC26634-00	THRIFT DRUG, INC.	RITE AID #11141	4000 WOODHAVEN ROAD	PHILADELPHIA	PA	19154	07/01/2025
CHC26634-00	WALGREEN EASTERN CO INC	DBA: WALGREENS # 04115	4201 N BROAD ST	PHILADELPHIA	PA	19140	07/01/2014	01/30/2025
CHC26634-00	WALGREEN EASTERN CO. INC.	DBA:WALGREENS #15336	1 SOUTH BROAD STREET	PHILADELPHIA	PA	19107	07/01/2014	02/28/2022
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1101 LOCUST ST.	PHILADELPHIA	PA	19107	07/01/2014	01/29/2025
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03569	4001 KENSINGTON AVE.	PHILADELPHIA	PA	19124	07/01/2014	08/07/2020
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	112 W CHELTEN AVE	PHILADELPHIA	PA	19144	07/01/2014
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05522	1607 BRIDGE ST	PHILADELPHIA	PA	19124	07/01/2014	11/15/2023
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05523	901 OLD YORK RD	JENKINTOWN	PA	19046	07/01/2014	07/27/2023
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06367	1809 E ALLEGHENY AVE	PHILADELPHIA	PA	19134	07/01/2014	03/02/2023
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	300 N. 63RD ST.	PHILADELPHIA	PA	19139	07/01/2014	01/31/2025
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07000	2060 STREET RD	WARRINGTON	PA	18976	07/01/2014	04/01/2022
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07151	901 MARKET STREET	PHILADELPHIA	PA	19107-3111	07/01/2014	11/21/2016
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07336	1617 JOHN F KENNEDY BLVD LBBY W8	PHILADELPHIA	PA	19103	07/01/2014
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16519	1334 BAINBRIDGE ST	PHILADELPHIA	PA	19147	07/01/2014
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #11595	245 N BROAD ST STE 1	PHILADELPHIA	PA	19107	07/01/2014
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11780	2655 SOUTH TENTH ST.	PHILADELPHIA	PA	19148	07/01/2014	03/01/2023
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1800 SOUTH ST.	PHILADELPHIA	PA	19146	07/01/2014
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15316	1227 LOCUST ST	PHILADELPHIA	PA	19107	07/01/2014
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03791	2014-24 S BROAD ST	PHILADELPHIA	PA	19145	01/01/2017
CHC26634-01	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15316	1227 LOCUST ST	PHILADELPHIA	PA	19107	01/01/2015
CHC26634-02	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15316	1227 LOCUST ST	PHILADELPHIA	PA	19107	10/01/2015
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07543	2310 W OREGON AVE	PHILADELPHIA	PA	19145-4122	04/01/2018
CHC26634-05	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15316	1227 LOCUST ST	PHILADELPHIA	PA	19107	01/01/2019
CHC26634-06	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15316	1227 LOCUST ST	PHILADELPHIA	PA	19107	01/01/2019	10/01/2020
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21251	3550 MARKET ST STE 103	PHILADELPHIA	PA	19104	07/01/2022
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07544	10000 BUSTLETON AVE	PHILADELPHIA	PA	19116-3748	07/01/2022
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03663	4098 EDGEMONT AVE.	BROOKHAVEN	PA	19015	07/01/2022
CHC26634-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04926	7001 FRANKFORD AVE	PHILADELPHIA	PA	19135	04/01/2023
CHC26634-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2017
CHC26634-00	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2017	10/01/2021
CHC26634-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2017
CHC26634-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2017

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Benitez, Jose CEO Philadelphia FIGHT 2159854448	Benitez, Jose A. CEO Philadelphia FIGHT 2159854448-102	6/18/2025 8:58 AM
Details	Last Recertification Date	Update	Recertification	2/7/2024 12:45:06 PM	2/19/2025 2:17:37 PM	2/19/2025 2:17 PM
Contacts	Authorizing Official	Update	AO Change Request	SHULL, JANE EXECUTIVE DIRECTOR Philadelphia FIGHT 2159854448-102	Benitez, Jose CEO Philadelphia FIGHT 2159854448	1/10/2025 10:36 AM
Addresses	Main Address	Update	Recertification	1207 Chestnut St. Philadelphia, PA 19107-4131	1207 Chestnut St, Philadelphia, PA 19107-4131	2/7/2024 12:45 PM
Details	Last Recertification Date	Update	Recertification	2/3/2023 10:41:06 AM	2/7/2024 12:45:06 PM	2/7/2024 12:45 PM
Contacts	Primary Contact	Update	Change Request	Smith, Sarah Chief Quality Officer Philadelphia FIGHT Community Health Centerse 2159854448-199	Landistratis, Greg Director of Revenue Cycle Philadelphia FIGHT 2159854448	8/1/2023 11:19 AM
Details	Last Recertification Date	Update	Recertification	2/1/2022 12:42:40 PM	2/3/2023 10:41:06 AM	2/3/2023 10:41 AM
Contacts	Primary Contact	Update	Recertification	Clemons, Dan Chief Financial Officer Philadelphia FIGHT 2159854448-106	Smith, Sarah Chief Quality Officer Philadelphia FIGHT Community Health Centerse 2159854448-199	2/1/2022 12:42 PM
Details	Last Recertification Date	Update	Recertification	2/17/2021 10:24:15 AM	2/1/2022 12:42:40 PM	2/1/2022 12:42 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1487082608 ( )		2/17/2021 10:24 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1487082608	2/17/2021 10:24 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	2/17/2021 10:24 AM
Details	Last Recertification Date	Update	Recertification	2/19/2020 2:39:51 PM	2/17/2021 10:24:15 AM	2/17/2021 10:24 AM
Details	Last Recertification Date	Update	Recertification	2/14/2019 11:24:28 AM	2/19/2020 2:39:51 PM	2/19/2020 2:39 PM
Addresses	Billing Address	Insert	Recertification		Philadelphia FIGHT 1233 Locust St., 3rd Fl Philadelphia, PA 19107	2/14/2019 11:24 AM
Details	Last Recertification Date	Update	Recertification	3/5/2018 3:08:24 PM	2/14/2019 11:24:28 AM	2/14/2019 11:24 AM
Details	Last Recertification Date	Update	Recertification	1/26/2017 12:00:00 AM	3/5/2018 3:08:24 PM	3/5/2018 3:08 PM
Contacts	Primary Contact	Update	Change Request	Kussay, Megan Pharmacist 2157901788-116	Clemons, Dan Chief Financial Officer Philadelphia FIGHT 2159854448-106	1/12/2018 5:21 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		1/12/2018 5:21 PM
Contacts	Authorizing Official	Update		SHULL, JANE EXECUTIVE DIRECTOR 2159854448-102	SHULL, JANE EXECUTIVE DIRECTOR Philadelphia FIGHT 2159854448-102	1/11/2018 1:17 PM
Contacts	Signed By	Update		SHULL, JANE EXECUTIVE DIRECTOR 2159854448-102	SHULL, JANE EXECUTIVE DIRECTOR Philadelphia FIGHT 2159854448-102	1/11/2018 1:17 PM
Contacts	Authorizing Official	Insert			SHULL, JANE EXECUTIVE DIRECTOR 2159854448-102	8/9/2017 2:05 PM
Contacts	Signed By	Insert			SHULL, JANE EXECUTIVE DIRECTOR 2159854448-102	8/9/2017 2:05 PM
Contacts	Primary Contact	Insert			Kussay, Megan Pharmacist 2157901788-116	1/27/2017 2:12 PM
Addresses	Main Address	Insert			1207 Chestnut St. Philadelphia, PA 19107-4131	1/26/2017 11:32 AM
Details	Last Recertification Date	Update		2/26/2016 12:00:00 AM	1/26/2017 12:00:00 AM	1/26/2017 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/18/2016 12:10 PM
Medicaid Billing	Medicaid: Number	Insert			1007472220013	4/18/2016 12:10 PM
Medicaid Billing	Medicaid: State	Insert			PA	4/18/2016 12:10 PM
Medicaid Billing	NPI: Number	Insert			1487082608	4/18/2016 12:10 PM
Details	Last Recertification Date	Update			2/26/2016 12:00:00 AM	2/26/2016 9:28 AM
Dates	Participating Approval Date	Update			7/20/2015 12:00:00 AM	7/20/2015 10:40 AM
Details	State	Update		Pending	Active	7/20/2015 10:40 AM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	7/20/2015 10:40 AM
Details	340B ID	Update		ONLINE_REG_53210	CHC26634-02	7/20/2015 10:34 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_53210	7/13/2015 10:30 AM
Details	Last Recertification Date	Insert				7/13/2015 10:30 AM
Details	Grant Number	Insert			H80CS26634	7/13/2015 10:30 AM
Details	340B ID	Insert			ONLINE_REG	7/13/2015 10:30 AM
Details	Is Authorizing Official EHB Data	Insert			False	7/13/2015 10:30 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/13/2015 10:30 AM
Details	Medicare Provider Number	Insert				7/13/2015 10:30 AM
Details	Entity Name	Insert			PHILADELPHIA FIGHT	7/13/2015 10:30 AM
Details	Program Code	Insert			CH	7/13/2015 10:30 AM
Details	Entity Subname	Insert			John Bell Clinic	7/13/2015 10:30 AM
Dates	Participating Approval Date	Insert				7/13/2015 10:30 AM
Details	State	Insert			Pending	7/13/2015 10:30 AM
Dates	Registration Date	Insert			7/13/2015 12:00:00 AM	7/13/2015 10:30 AM
Dates	Signed By Date	Insert			7/13/2015 12:00:00 AM	7/13/2015 10:30 AM
Dates	Start Date	Insert				7/13/2015 10:30 AM
Terminations	Termination Comments	Insert				7/13/2015 10:30 AM
Terminations	Termination Date	Insert				7/13/2015 10:30 AM
Terminations	Termination Effective Date	Insert				7/13/2015 10:30 AM
Terminations	Termination Reason	Insert				7/13/2015 10:30 AM

340B Drug Pricing Program Database