340B Drug Pricing Program Database


CH03414A SPECTRUM HEALTH SERVICES, INC. (Active) - information as of 4/30/2025 10:56:18 PM

Main Details
SPECTRUM HEALTH SERVICES, INC.
BROAD STREET HEALTH CENTER
HRSA-Funded Health Center
BPS-H80-002951
CH03414A
H80CS00389


Additional Details
Active
7/13/2016
10/1/2016
7/21/2016
2/13/2025

Contacts

Spectrum Health Services, Inc
Shawna L Russell-Young, Chief Compliance Officer
(215) 668-0847

Spectrum Health Services, Inc.
Suzanne Brown, Director of Pharmacy Services
(267) 769-2512

Addresses

1415 N Broad St STE 224
Philadelphia, PA 19122-3325

Spectrum Health Services, Inc
5201 Haverford Avenue
Philadelphia, PA 19139


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA10072882600051881629012
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailBEST CARE PHARMACY257 N 52ND ST
PHILADELPHIAPA1913904/03/201907/01/2019 02/12/202407/17/2024
Contract DetailBEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410804/03/201907/01/2019 07/12/201907/12/2019
Contract DetailBEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410807/12/201910/01/2019 01/15/202110/05/2023
Contract DetailBEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914104/15/201907/01/2019 07/12/201907/12/2019
Contract DetailBEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914107/12/201910/01/2019 04/08/202110/05/2023
Contract DetailCOORDINATED CARE NETWORKCOORDINATED CARE NETWORK 300 PENN CENTER BLVD STE 405
PITTSBURGHPA15235-551104/03/201907/01/2019  07/01/2019
Contract DetailECKERD CORPORATIONRITE AID #11124 4055-89 MARKET STREET
PHILADELPHIAPA1910404/03/201907/01/2019 08/24/202310/05/2023
Contract DetailECKERD CORPORATIONRITE AID #11125 7418 OXFORD AVE
PHILADELPHIAPA1911107/15/201910/01/2019 08/24/202310/05/2023
Contract DetailECKERD CORPORATIONRITE AID #11136 1334 WINDRIM AVENUE
PHILADELPHIAPA1914104/15/202507/01/2025  04/15/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02704 4849 MARKET ST.
PHILADELPHIAPA1913904/03/201907/01/2019  07/01/2019
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02755 4314 LOCUST STREET
PHILADELPHIAPA1910410/05/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02077 1901 WEST OREGON AVENUE
PHILADELPHIAPA1914510/05/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11219 1138 N. 2ND STREET
PHILADELPHIAPA1912304/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02397 8525 FRANKFORD AVENUE
PHILADELPHIAPA1913604/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02266 6900 LINDBERGH BLVD.
PHILADELPHIAPA1914204/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11371 1717 NORTH 12TH STREET, UNIT F
PHILADELPHIAPA1912204/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00371 6501 HARBISON AVENUE
PHILADELPHIAPA1914904/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00460 101 CHESTER AVENUE
YEADONPA1905004/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03142 119 E. BALTIMORE AVE.
LANSDOWNEPA1905004/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05867 401 SPRING GARDEN ST.
PHILADELPHIAPA1912304/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5081 101 W CITY AVENUE
BALA CYNWYDPA1900404/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02408 802 N LANSDOWNE AVE
DREXEL HILLPA1902604/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02159 2320-26 FAIRMOUNT AVENUE
PHILADELPHIAPA1913004/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02222 7520 CITY LINE AVE.
PHILADELPHIAPA1915104/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10090 2132 SOUTH STREET
PHILADELPHIAPA1914604/09/202507/01/2025  04/09/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02074 4133 G ST.
PHILADELPHIAPA1912404/09/202507/01/2025  04/09/2025
Contract DetailPREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170604/03/201907/01/2019 10/22/202010/05/2023
Contract DetailPREMIER PHARMACY SERVICESGOOD HEALTH INC. 1049-51 BROADWAY
#2
BETHLEHEMPA18015-414804/03/201907/01/2019 10/22/202010/05/2023
Contract DetailRITE AID OF NEW JERSEY, INC.RITE AID #135 217 SUNSET ROAD
WILLINGBORONJ0804604/15/202507/01/2025  04/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912104/03/201907/01/2019 05/30/201905/30/2019
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3213 4641-51 CHESTNUT STREET
PHILADELPHIAPA1913904/03/201907/01/2019 08/24/202310/05/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913904/03/201907/01/2019 08/24/202310/05/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914304/03/201907/01/2019 08/24/202310/05/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1127 2131-59 NORTH BROAD STREET
PHILADELPHIAPA1912204/03/201907/01/2019 08/24/202310/05/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3227 3000-02 REED STREET
PHILADELPHIAPA1914604/03/201907/01/2019 08/24/202310/05/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912107/08/201910/01/2019 08/24/202310/05/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #4611 5040 CITY LINE AVENUE
PHILADELPHIAPA1913104/15/202507/01/2025  04/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913904/15/202507/01/2025  04/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #872 164 WEST CHELTEN AVENUE
PHILADELPHIAPA1914404/15/202507/01/2025  04/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3523 1105-09 N. 63RD STREET
PHILADELPHIAPA1915104/15/202507/01/2025  04/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #478 5400 RISING SUN AVENUE
PHILADELPHIAPA1912004/15/202507/01/2025  04/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914304/15/202507/01/2025  04/15/2025
Contract DetailRITECHOICE PHARMACY IV4700 WISSAHICKON AVE BUILDING E, SUITE 100
PHILADELPHIAPA1914404/03/201907/01/2019 07/30/202007/30/2020
Contract DetailRITECHOICE PHARMACY V5201 HAVERFORD AVE FL 1
PHILADELPHIAPA19139-140107/11/201910/01/2019  10/01/2019
Contract DetailSUN RAY DRUG, LLC142 S 52ND STREET
PHILADELPHIAPA1913910/05/202301/01/2024  01/01/2024
Contract DetailSUNRAY DRUGS PROGRESS PLAZA1501 N BROAD ST STE 9
PHILADELPHIAPA1912204/03/201907/01/2019  07/01/2019
Contract DetailSUNRAY DRUGS SPECIALTY142 S 52ND ST SUITE 201
PHILADELPHIAPA1913910/05/202301/01/2024  01/01/2024
Contract DetailTHRIFT DRUG, INC.RITE AID #11130 7700 CRITTENDEN STREET
SUITE 101C
PHILADELPHIAPA1911804/15/202507/01/2025  04/15/2025
Contract DetailTHRIFT DRUG, INC.RITE AID #11122 284 EAST LANCASTER AVENUE
WYNNEWOODPA1909604/15/202507/01/2025  04/15/2025
Contract DetailTHRIFT DRUG, INC.RITE AID #11105 832 NORTH LANSDOWNE AVE.
DREXEL HILLPA1902604/15/202507/01/2025  04/15/2025
Contract DetailWAL-MART PHARMACY 10-20402106 MT HOLLY RD
BURLINGTONNJ0801604/03/201907/01/2019 07/08/201907/08/2019
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/03/201907/01/2019 07/08/201907/08/2019
Contract DetailWALMART PHARMACY 10-35852901 RILEY FUZZELL RD
SPRINGTX7738604/03/201907/01/2019 07/08/201907/08/2019
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH034140ActiveBPS-H80-012685SPECTRUM HEALTH SERVICES, INC.Spectrum Community Health Center5201 Haverford Avenue PhiladelphiaPA
CH03414AActiveBPS-H80-002951SPECTRUM HEALTH SERVICES, INC.BROAD STREET HEALTH CENTER1415 N Broad St STE 224 PhiladelphiaPA
CH03414BActiveBPS-H80-017169SPECTRUM HEALTH SERVICES, INC.Reed Street Health Center1325 South 33rd StreetSuite 300PhiladelphiaPA
CH03414CActiveBPS-H80-033716SPECTRUM HEALTH SERVICESCottman Avenue Health Center3525 Cottman Ave PhiladelphiaPA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH034140BEST CARE PHARMACY257 N 52ND ST
PHILADELPHIAPA1913901/01/2019 02/12/2024
CH03414ABEST CARE PHARMACY257 N 52ND ST
PHILADELPHIAPA1913907/01/2019 02/12/2024
CH03414BBEST CARE PHARMACY257 N 52ND ST
PHILADELPHIAPA1913907/01/2019 02/12/2024
CH03414ABEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410807/01/2019 07/12/2019
CH03414BBEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410807/01/2019 07/12/2019
CH034140BEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410807/01/2019 06/12/2019
CH034140BEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410810/01/2019 01/15/2021
CH03414ABEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410810/01/2019 01/15/2021
CH03414BBEST CARE PHARMACY II269 S 52ND STREET
PHILADELPHIAPA19139-410810/01/2019 01/15/2021
CH034140BEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914107/01/2019 06/12/2019
CH03414ABEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914107/01/2019 07/12/2019
CH03414BBEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914107/01/2019 07/12/2019
CH034140BEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914110/01/2019 04/08/2021
CH03414ABEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914110/01/2019 04/08/2021
CH03414BBEST CARE PHARMACY III4931 N BROAD ST
PHILADELPHIAPA1914110/01/2019 04/08/2021
CH034140COORDINATED CARE NETWORKCOORDINATED CARE NETWORK 300 PENN CENTER BLVD STE 405
PITTSBURGHPA15235-551110/21/2010  
CH03414ACOORDINATED CARE NETWORKCOORDINATED CARE NETWORK 300 PENN CENTER BLVD STE 405
PITTSBURGHPA15235-551107/01/2019  
CH03414BCOORDINATED CARE NETWORKCOORDINATED CARE NETWORK 300 PENN CENTER BLVD STE 405
PITTSBURGHPA15235-551107/01/2019  
CH03414CCOORDINATED CARE NETWORKCOORDINATED CARE NETWORK 300 PENN CENTER BLVD STE 405
PITTSBURGHPA15235-551101/01/2024  
CH034140ECKERD CORPORATIONRITE AID #11124 4055-89 MARKET STREET
PHILADELPHIAPA1910401/01/2019 08/24/2023
CH03414AECKERD CORPORATIONRITE AID #11124 4055-89 MARKET STREET
PHILADELPHIAPA1910407/01/2019 08/24/2023
CH03414BECKERD CORPORATIONRITE AID #11124 4055-89 MARKET STREET
PHILADELPHIAPA1910407/01/2019 08/24/2023
CH034140ECKERD CORPORATIONRITE AID #11125 7418 OXFORD AVE
PHILADELPHIAPA1911110/01/2019 07/15/2019
CH034140ECKERD CORPORATIONRITE AID #11125 7418 OXFORD AVE
PHILADELPHIAPA1911110/01/2019 08/24/2023
CH03414AECKERD CORPORATIONRITE AID #11125 7418 OXFORD AVE
PHILADELPHIAPA1911110/01/2019 08/24/2023
CH03414BECKERD CORPORATIONRITE AID #11125 7418 OXFORD AVE
PHILADELPHIAPA1911110/01/2019 08/24/2023
CH03414AECKERD CORPORATIONRITE AID #11136 1334 WINDRIM AVENUE
PHILADELPHIAPA1914107/01/2025  
CH03414CECKERD CORPORATIONRITE AID #11136 1334 WINDRIM AVENUE
PHILADELPHIAPA1914107/01/2025  
CH03414BECKERD CORPORATIONRITE AID #11136 1334 WINDRIM AVENUE
PHILADELPHIAPA1914107/01/2025  
CH034140ECKERD CORPORATIONRITE AID #11136 1334 WINDRIM AVENUE
PHILADELPHIAPA1914107/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02704 4849 MARKET ST.
PHILADELPHIAPA1913901/01/2019  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02704 4849 MARKET ST.
PHILADELPHIAPA1913907/01/2019  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02704 4849 MARKET ST.
PHILADELPHIAPA1913907/01/2019  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02077 1901 WEST OREGON AVENUE
PHILADELPHIAPA1914507/01/2021  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02755 4314 LOCUST STREET
PHILADELPHIAPA1910407/01/2021  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02755 4314 LOCUST STREET
PHILADELPHIAPA1910401/01/2024  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02077 1901 WEST OREGON AVENUE
PHILADELPHIAPA1914501/01/2024  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02755 4314 LOCUST STREET
PHILADELPHIAPA1910401/01/2024  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02077 1901 WEST OREGON AVENUE
PHILADELPHIAPA1914501/01/2024  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02755 4314 LOCUST STREET
PHILADELPHIAPA1910401/01/2024  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02704 4849 MARKET ST.
PHILADELPHIAPA1913901/01/2024  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02077 1901 WEST OREGON AVENUE
PHILADELPHIAPA1914501/01/2024  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02159 2320-26 FAIRMOUNT AVENUE
PHILADELPHIAPA1913007/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00460 101 CHESTER AVENUE
YEADONPA1905007/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02222 7520 CITY LINE AVE.
PHILADELPHIAPA1915107/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00371 6501 HARBISON AVENUE
PHILADELPHIAPA1914907/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02074 4133 G ST.
PHILADELPHIAPA1912407/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03142 119 E. BALTIMORE AVE.
LANSDOWNEPA1905007/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02408 802 N LANSDOWNE AVE
DREXEL HILLPA1902607/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11371 1717 NORTH 12TH STREET, UNIT F
PHILADELPHIAPA1912207/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11219 1138 N. 2ND STREET
PHILADELPHIAPA1912307/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10090 2132 SOUTH STREET
PHILADELPHIAPA1914607/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5081 101 W CITY AVENUE
BALA CYNWYDPA1900407/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05867 401 SPRING GARDEN ST.
PHILADELPHIAPA1912307/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02397 8525 FRANKFORD AVENUE
PHILADELPHIAPA1913607/01/2025  
CH034140PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02266 6900 LINDBERGH BLVD.
PHILADELPHIAPA1914207/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02266 6900 LINDBERGH BLVD.
PHILADELPHIAPA1914207/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11371 1717 NORTH 12TH STREET, UNIT F
PHILADELPHIAPA1912207/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02222 7520 CITY LINE AVE.
PHILADELPHIAPA1915107/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00371 6501 HARBISON AVENUE
PHILADELPHIAPA1914907/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05867 401 SPRING GARDEN ST.
PHILADELPHIAPA1912307/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5081 101 W CITY AVENUE
BALA CYNWYDPA1900407/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02222 7520 CITY LINE AVE.
PHILADELPHIAPA1915107/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11371 1717 NORTH 12TH STREET, UNIT F
PHILADELPHIAPA1912207/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11219 1138 N. 2ND STREET
PHILADELPHIAPA1912307/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02266 6900 LINDBERGH BLVD.
PHILADELPHIAPA1914207/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02159 2320-26 FAIRMOUNT AVENUE
PHILADELPHIAPA1913007/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03142 119 E. BALTIMORE AVE.
LANSDOWNEPA1905007/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02397 8525 FRANKFORD AVENUE
PHILADELPHIAPA1913607/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02266 6900 LINDBERGH BLVD.
PHILADELPHIAPA1914207/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00460 101 CHESTER AVENUE
YEADONPA1905007/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11371 1717 NORTH 12TH STREET, UNIT F
PHILADELPHIAPA1912207/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10090 2132 SOUTH STREET
PHILADELPHIAPA1914607/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11219 1138 N. 2ND STREET
PHILADELPHIAPA1912307/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00371 6501 HARBISON AVENUE
PHILADELPHIAPA1914907/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5081 101 W CITY AVENUE
BALA CYNWYDPA1900407/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00460 101 CHESTER AVENUE
YEADONPA1905007/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03142 119 E. BALTIMORE AVE.
LANSDOWNEPA1905007/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05867 401 SPRING GARDEN ST.
PHILADELPHIAPA1912307/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02408 802 N LANSDOWNE AVE
DREXEL HILLPA1902607/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5081 101 W CITY AVENUE
BALA CYNWYDPA1900407/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02408 802 N LANSDOWNE AVE
DREXEL HILLPA1902607/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02159 2320-26 FAIRMOUNT AVENUE
PHILADELPHIAPA1913007/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02074 4133 G ST.
PHILADELPHIAPA1912407/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02397 8525 FRANKFORD AVENUE
PHILADELPHIAPA1913607/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00371 6501 HARBISON AVENUE
PHILADELPHIAPA1914907/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02397 8525 FRANKFORD AVENUE
PHILADELPHIAPA1913607/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02408 802 N LANSDOWNE AVE
DREXEL HILLPA1902607/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02159 2320-26 FAIRMOUNT AVENUE
PHILADELPHIAPA1913007/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02074 4133 G ST.
PHILADELPHIAPA1912407/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02222 7520 CITY LINE AVE.
PHILADELPHIAPA1915107/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05867 401 SPRING GARDEN ST.
PHILADELPHIAPA1912307/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10090 2132 SOUTH STREET
PHILADELPHIAPA1914607/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00460 101 CHESTER AVENUE
YEADONPA1905007/01/2025  
CH03414CPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10090 2132 SOUTH STREET
PHILADELPHIAPA1914607/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03142 119 E. BALTIMORE AVE.
LANSDOWNEPA1905007/01/2025  
CH03414APENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02074 4133 G ST.
PHILADELPHIAPA1912407/01/2025  
CH03414BPENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY #11219 1138 N. 2ND STREET
PHILADELPHIAPA1912307/01/2025  
CH034140PREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170601/01/2019 10/22/2020
CH034140PREMIER PHARMACY SERVICESGOOD HEALTH INC. 1049-51 BROADWAY
#2
BETHLEHEMPA18015-414801/01/2019 10/22/2020
CH03414APREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170607/01/2019 10/22/2020
CH03414APREMIER PHARMACY SERVICESGOOD HEALTH INC. 1049-51 BROADWAY
#2
BETHLEHEMPA18015-414807/01/2019 10/22/2020
CH03414BPREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170607/01/2019 10/22/2020
CH03414BPREMIER PHARMACY SERVICESGOOD HEALTH INC. 1049-51 BROADWAY
#2
BETHLEHEMPA18015-414807/01/2019 10/22/2020
CH03414ARITE AID OF NEW JERSEY, INC.RITE AID #135 217 SUNSET ROAD
WILLINGBORONJ0804607/01/2025  
CH03414BRITE AID OF NEW JERSEY, INC.RITE AID #135 217 SUNSET ROAD
WILLINGBORONJ0804607/01/2025  
CH03414CRITE AID OF NEW JERSEY, INC.RITE AID #135 217 SUNSET ROAD
WILLINGBORONJ0804607/01/2025  
CH034140RITE AID OF NEW JERSEY, INC.RITE AID #135 217 SUNSET ROAD
WILLINGBORONJ0804607/01/2025  
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913901/01/2019 08/24/2023
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #3681 5440 LANSDOWNE AVENUE
PHILADELPHIAPA1913101/01/2019 08/24/2023
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914301/01/2019 08/24/2023
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #1127 2131-59 NORTH BROAD STREET
PHILADELPHIAPA1912201/01/2019 08/24/2024
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #3227 3000-02 REED STREET
PHILADELPHIAPA1914601/01/2019 08/24/2023
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912107/01/2019 05/30/2019
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #3213 4641-51 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2019 08/24/2023
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2019 08/24/2023
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914307/01/2019 08/24/2023
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #1127 2131-59 NORTH BROAD STREET
PHILADELPHIAPA1912207/01/2019 08/24/2023
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #3227 3000-02 REED STREET
PHILADELPHIAPA1914607/01/2019 08/24/2023
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912107/01/2019 05/30/2019
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #3213 4641-51 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2019 05/30/2019
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912107/01/2019 05/30/2019
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #3213 4641-51 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2019 05/30/2019
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2019 08/24/2023
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914307/01/2019 08/24/2023
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #1127 2131-59 NORTH BROAD STREET
PHILADELPHIAPA1912207/01/2019 08/24/2023
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #3227 3000-02 REED STREET
PHILADELPHIAPA1914607/01/2019 08/24/2023
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #3213 4641-51 CHESTNUT STREET
PHILADELPHIAPA1913910/01/2019 08/24/2023
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912110/01/2019 08/24/2023
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #2790 1406 CECIL B MOORE AVE
PHILADELPHIAPA1912110/01/2019 08/24/2023
CH03414CRITE AID OF PENNSYLVANIA, LLCRITE AID #3523 1105-09 N. 63RD STREET
PHILADELPHIAPA1915107/01/2025  
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #478 5400 RISING SUN AVENUE
PHILADELPHIAPA1912007/01/2025  
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #478 5400 RISING SUN AVENUE
PHILADELPHIAPA1912007/01/2025  
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2025  
CH03414CRITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2025  
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #872 164 WEST CHELTEN AVENUE
PHILADELPHIAPA1914407/01/2025  
CH03414CRITE AID OF PENNSYLVANIA, LLCRITE AID #872 164 WEST CHELTEN AVENUE
PHILADELPHIAPA1914407/01/2025  
CH03414CRITE AID OF PENNSYLVANIA, LLCRITE AID #478 5400 RISING SUN AVENUE
PHILADELPHIAPA1912007/01/2025  
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #4611 5040 CITY LINE AVENUE
PHILADELPHIAPA1913107/01/2025  
CH03414CRITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914307/01/2025  
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #872 164 WEST CHELTEN AVENUE
PHILADELPHIAPA1914407/01/2025  
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #3523 1105-09 N. 63RD STREET
PHILADELPHIAPA1915107/01/2025  
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914307/01/2025  
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #4611 5040 CITY LINE AVENUE
PHILADELPHIAPA1913107/01/2025  
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2025  
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914307/01/2025  
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #872 164 WEST CHELTEN AVENUE
PHILADELPHIAPA1914407/01/2025  
CH03414BRITE AID OF PENNSYLVANIA, LLCRITE AID #1764 5627-99 CHESTNUT STREET
PHILADELPHIAPA1913907/01/2025  
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #4611 5040 CITY LINE AVENUE
PHILADELPHIAPA1913107/01/2025  
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #3523 1105-09 N. 63RD STREET
PHILADELPHIAPA1915107/01/2025  
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #478 5400 RISING SUN AVENUE
PHILADELPHIAPA1912007/01/2025  
CH03414ARITE AID OF PENNSYLVANIA, LLCRITE AID #2451 5214-30 BALTIMORE AVENUE
PHILADELPHIAPA1914307/01/2025  
CH034140RITE AID OF PENNSYLVANIA, LLCRITE AID #3523 1105-09 N. 63RD STREET
PHILADELPHIAPA1915107/01/2025  
CH03414CRITE AID OF PENNSYLVANIA, LLCRITE AID #4611 5040 CITY LINE AVENUE
PHILADELPHIAPA1913107/01/2025  
CH034140RITECHOICE PHARMACY IV4700 WISSAHICKON AVE BUILDING E, SUITE 100
PHILADELPHIAPA1914401/01/2019 07/30/2020
CH03414ARITECHOICE PHARMACY IV4700 WISSAHICKON AVE BUILDING E, SUITE 100
PHILADELPHIAPA1914407/01/2019 07/30/2020
CH03414BRITECHOICE PHARMACY IV4700 WISSAHICKON AVE BUILDING E, SUITE 100
PHILADELPHIAPA1914407/01/2019 07/30/2020
CH034140RITECHOICE PHARMACY V5201 HAVERFORD AVE FL 1
PHILADELPHIAPA19139-140110/01/2019  
CH03414ARITECHOICE PHARMACY V5201 HAVERFORD AVE FL 1
PHILADELPHIAPA19139-140110/01/2019  
CH03414BRITECHOICE PHARMACY V5201 HAVERFORD AVE FL 1
PHILADELPHIAPA19139-140110/01/2019  
CH03414CRITECHOICE PHARMACY V5201 HAVERFORD AVE FL 1
PHILADELPHIAPA19139-140101/01/2024  
CH034140SUN RAY DRUG, LLC142 S 52ND STREET
PHILADELPHIAPA1913910/01/2020  
CH03414ASUN RAY DRUG, LLC142 S 52ND STREET
PHILADELPHIAPA1913901/01/2024  
CH03414BSUN RAY DRUG, LLC142 S 52ND STREET
PHILADELPHIAPA1913901/01/2024  
CH03414CSUN RAY DRUG, LLC142 S 52ND STREET
PHILADELPHIAPA1913901/01/2024  
CH034140SUNRAY DRUGS PROGRESS PLAZA1501 N BROAD ST STE 9
PHILADELPHIAPA1912201/01/2019  
CH03414ASUNRAY DRUGS PROGRESS PLAZA1501 N BROAD ST STE 9
PHILADELPHIAPA1912207/01/2019  
CH03414BSUNRAY DRUGS PROGRESS PLAZA1501 N BROAD ST STE 9
PHILADELPHIAPA1912207/01/2019  
CH034140SUNRAY DRUGS SPECIALTY142 S 52ND ST SUITE 201
PHILADELPHIAPA1913910/01/2020  
CH03414ASUNRAY DRUGS SPECIALTY142 S 52ND ST SUITE 201
PHILADELPHIAPA1913901/01/2024  
CH03414BSUNRAY DRUGS SPECIALTY142 S 52ND ST SUITE 201
PHILADELPHIAPA1913901/01/2024  
CH03414CSUNRAY DRUGS SPECIALTY142 S 52ND ST SUITE 201
PHILADELPHIAPA1913901/01/2024  
CH034140THRIFT DRUG, INC.RITE AID #11122 284 EAST LANCASTER AVENUE
WYNNEWOODPA1909607/01/2025  
CH03414ATHRIFT DRUG, INC.RITE AID #11130 7700 CRITTENDEN STREET
SUITE 101C
PHILADELPHIAPA1911807/01/2025  
CH03414ATHRIFT DRUG, INC.RITE AID #11122 284 EAST LANCASTER AVENUE
WYNNEWOODPA1909607/01/2025  
CH03414CTHRIFT DRUG, INC.RITE AID #11130 7700 CRITTENDEN STREET
SUITE 101C
PHILADELPHIAPA1911807/01/2025  
CH03414CTHRIFT DRUG, INC.RITE AID #11122 284 EAST LANCASTER AVENUE
WYNNEWOODPA1909607/01/2025  
CH03414BTHRIFT DRUG, INC.RITE AID #11105 832 NORTH LANSDOWNE AVE.
DREXEL HILLPA1902607/01/2025  
CH03414BTHRIFT DRUG, INC.RITE AID #11122 284 EAST LANCASTER AVENUE
WYNNEWOODPA1909607/01/2025  
CH034140THRIFT DRUG, INC.RITE AID #11105 832 NORTH LANSDOWNE AVE.
DREXEL HILLPA1902607/01/2025  
CH03414ATHRIFT DRUG, INC.RITE AID #11105 832 NORTH LANSDOWNE AVE.
DREXEL HILLPA1902607/01/2025  
CH03414CTHRIFT DRUG, INC.RITE AID #11105 832 NORTH LANSDOWNE AVE.
DREXEL HILLPA1902607/01/2025  
CH034140THRIFT DRUG, INC.RITE AID #11130 7700 CRITTENDEN STREET
SUITE 101C
PHILADELPHIAPA1911807/01/2025  
CH03414BTHRIFT DRUG, INC.RITE AID #11130 7700 CRITTENDEN STREET
SUITE 101C
PHILADELPHIAPA1911807/01/2025  
CH034140WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2019 07/08/2019
CH03414BWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/01/2019 07/08/2019
CH034140WAL-MART PHARMACY 10-20402106 MT HOLLY RD
BURLINGTONNJ0801601/01/2019 07/08/2019
CH03414AWAL-MART PHARMACY 10-20402106 MT HOLLY RD
BURLINGTONNJ0801607/01/2019 07/08/2019
CH03414BWAL-MART PHARMACY 10-20402106 MT HOLLY RD
BURLINGTONNJ0801607/01/2019 07/08/2019
CH034140WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2019 07/08/2019
CH03414AWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/01/2019 07/08/2019
CH03414AWALMART PHARMACY 10-35852901 RILEY FUZZELL RD
SPRINGTX7738607/01/2019 07/08/2019
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/23/2024 3:51:24 PM2/13/2025 12:33:04 PM2/13/2025 12:33 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestRussell-Young, Shawna L VP, Compliance Spectrum Health Services, Inc 2156680847Russell-Young, Shawna L Chief Compliance Officer Spectrum Health Services, Inc 21566808477/8/2024 8:02 AM
ContactsPrimary ContactUpdateChange RequestGraves, Karen L Chief Financial Officer Spectrum Health Services, Inc. 2159363118Brown, Suzanne Director of Pharmacy Services Spectrum Health Services, Inc. 26776925127/3/2024 11:49 AM
DetailsLast Recertification DateUpdateRecertification2/21/2023 3:23:12 PM2/23/2024 3:51:24 PM2/23/2024 3:51 PM
ContactsPrimary ContactUpdate Graves, Karen Chief Financial Officer Spectrum Health Services, Inc. 2159363118Graves, Karen L Chief Financial Officer Spectrum Health Services, Inc. 215936311810/6/2023 1:07 PM
ContactsPrimary ContactUpdateChange RequestDeMilio, David B. Chief Financial Officer Spectrum Health Services, Inc. 2154712920Graves, Karen Chief Financial Officer Spectrum Health Services, Inc. 215936311810/5/2023 5:36 PM
DetailsLast Recertification DateUpdateRecertification2/22/2022 4:20:25 PM2/21/2023 3:23:12 PM2/21/2023 3:23 PM
DetailsLast Recertification DateUpdateRecertification2/18/2021 2:29:28 PM2/22/2022 4:20:25 PM2/22/2022 4:20 PM
Medicaid BillingNPI: NumberDeleteRecertification1881629012 ( ) 2/18/2021 2:29 PM
Medicaid BillingNPI: NumberInsertRecertification 18816290122/18/2021 2:29 PM
Medicaid BillingNPI: StateInsertRecertification PA2/18/2021 2:29 PM
DetailsLast Recertification DateUpdateRecertification2/18/2020 3:16:47 PM2/18/2021 2:29:28 PM2/18/2021 2:29 PM
ContactsAuthorizing OfficialUpdateChange RequestGraves, Karen L Chief Compliance Officer Spectrum Health Services 2679905338-2014179086Russell-Young, Shawna L VP, Compliance Spectrum Health Services, Inc 215668084711/18/2020 7:14 AM
ContactsPrimary ContactUpdateChange RequestPendelton, Robyn 340B Program Manager Spectrum Health Services, Inc. 2678963957DeMilio, David B. Chief Financial Officer Spectrum Health Services, Inc. 21547129207/22/2020 6:28 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/8/2020 2:03 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10072882600057/8/2020 2:03 PM
Medicaid BillingMedicaid: StateInsertChange Request PA7/8/2020 2:03 PM
Medicaid BillingNPI: NumberInsertChange Request 18816290127/8/2020 2:03 PM
ContactsAuthorizing OfficialUpdateChange RequestGraves, Karen L Chief Compliance Officer Spectrum Health Services 2679905338Graves, Karen L Chief Compliance Officer Spectrum Health Services 2679905338-20141790866/16/2020 2:14 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestGraves, Karen L Chief Compliance Officer Spectrum Health Services 2679905338-2014179086Graves, Karen L Chief Compliance Officer Spectrum Health Services 26799053386/2/2020 2:21 PM
ContactsPrimary ContactUpdateChange RequestDeMilio, David B. Chief Financial Officer Spectrum Health Services, Inc. 2154712920Pendelton, Robyn 340B Program Manager Spectrum Health Services, Inc. 26789639575/13/2020 10:52 AM
ContactsAuthorizing OfficialUpdateChange RequestGraves, Karen L Chief Compliance Officer Spectrum Health Services 2679905338Graves, Karen L Chief Compliance Officer Spectrum Health Services 2679905338-20141790865/13/2020 10:46 AM
ContactsAuthorizing OfficialUpdateAO Change RequestEnakhimion, Yahaya Ehigie Chief Operating Officer Spectrum Health Services, Inc. 2677694896Graves, Karen L Chief Compliance Officer Spectrum Health Services 26799053385/11/2020 2:09 PM
DetailsLast Recertification DateUpdateRecertification2/22/2019 8:34:06 AM2/18/2020 3:16:47 PM2/18/2020 3:16 PM
ContactsAuthorizing OfficialUpdateChange RequestWroten, Stephanie Chief Programs and Develop Spectrum Health Services Inc 2154712761-3256Enakhimion, Yahaya Ehigie Chief Operating Officer Spectrum Health Services, Inc. 267769489611/15/2019 12:51 PM
ContactsPrimary ContactUpdateRecertificationEmmanuel, Yvonne T. Director of Administrative Services Spectrum Health Services, Inc. 2154712756DeMilio, David B. Chief Financial Officer Spectrum Health Services, Inc. 21547129202/22/2019 8:34 AM
DetailsLast Recertification DateUpdateRecertification3/5/2018 1:35:04 PM2/22/2019 8:34:06 AM2/22/2019 8:34 AM
ContactsAuthorizing OfficialUpdateAO Change RequestCater, Phyllis B. President & CEO Spectrum Health Services, Inc. 2154712755Wroten, Stephanie Chief Programs and Develop Spectrum Health Services Inc 2154712761-32562/22/2019 7:21 AM
ContactsPrimary ContactUpdateRecertificationHaynes, Curtis CFO 2154712924Emmanuel, Yvonne T. Director of Administrative Services Spectrum Health Services, Inc. 21547127563/5/2018 1:35 PM
DetailsLast Recertification DateUpdateRecertification2/6/2017 12:00:00 AM3/5/2018 1:35:04 PM3/5/2018 1:35 PM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 3/5/2018 1:35 PM
ContactsAuthorizing OfficialUpdate Cater, Phyllis B. President & CEO 2154712755Cater, Phyllis B. President & CEO Spectrum Health Services, Inc. 21547127552/9/2018 3:35 PM
ContactsSigned ByUpdate Cater, Phyllis B. President & CEO 2154712755Cater, Phyllis B. President & CEO Spectrum Health Services, Inc. 21547127552/9/2018 3:35 PM
ContactsAuthorizing OfficialInsert  Cater, Phyllis B. President & CEO 21547127555/12/2017 12:21 PM
ContactsSigned ByInsert  Cater, Phyllis B. President & CEO 21547127555/12/2017 12:21 PM
ContactsPrimary ContactInsert  Haynes, Curtis CFO 21547129242/6/2017 1:21 PM
AddressesMain AddressInsert   1415 N Broad St STE 224 Philadelphia, PA 19122-33252/6/2017 1:21 PM
DetailsLast Recertification DateUpdate  2/6/2017 12:00:00 AM2/6/2017 1:20 PM
AddressesBilling AddressInsert  Spectrum Health Services, Inc 5201 Haverford Avenue Philadelphia, PA 191397/21/2016 11:52 AM
DatesParticipating Approval DateUpdate  7/21/2016 12:00:00 AM7/21/2016 11:52 AM
DetailsStateUpdate PendingActive7/21/2016 11:52 AM
DatesStart DateUpdate  10/1/2016 12:00:00 AM7/21/2016 11:52 AM
Details340B IDUpdate ONLINE_REG_71524CH03414A7/20/2016 10:30 AM
Details340B IDUpdate ONLINE_REGONLINE_REG_715247/13/2016 11:08 AM
DetailsLast Recertification DateInsert   7/13/2016 11:08 AM
DetailsGrant NumberInsert  H80CS003897/13/2016 11:08 AM
Details340B IDInsert  ONLINE_REG7/13/2016 11:08 AM
DetailsIs Authorizing Official EHB DataInsert  False7/13/2016 11:08 AM
DatesLast Date That 340B Drugs PurchasedInsert   7/13/2016 11:08 AM
DetailsMedicare Provider NumberInsert   7/13/2016 11:08 AM
DetailsEntity NameInsert  SPECTRUM HEALTH SERVICES, INC.7/13/2016 11:08 AM
DetailsProgram CodeInsert  CH7/13/2016 11:08 AM
DetailsEntity SubnameInsert  BROAD STREET HEALTH CENTER7/13/2016 11:08 AM
DatesParticipating Approval DateInsert   7/13/2016 11:08 AM
DetailsStateInsert  Pending7/13/2016 11:08 AM
DatesRegistration DateInsert  7/13/2016 12:00:00 AM7/13/2016 11:08 AM
DatesSigned By DateInsert  7/13/2016 12:00:00 AM7/13/2016 11:08 AM
DatesStart DateInsert   7/13/2016 11:08 AM
TerminationsTermination CommentsInsert   7/13/2016 11:08 AM
TerminationsTermination DateInsert   7/13/2016 11:08 AM
TerminationsTermination Effective DateInsert   7/13/2016 11:08 AM
TerminationsTermination ReasonInsert   7/13/2016 11:08 AM