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FP191071 MAZZONI CENTER (Terminated)
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Main Details
Name
MAZZONI CENTER
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP191071
Grant Number
FPHPA006433
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2003
Participating Start Date
4/1/2003
Participating Approval Date
4/1/2003
Last Recertification Date
5/17/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Mazzoni Center
Alecia Manley, Executive Operating Officer
(215) 563-0652
Primary Contact
Mazzoni Center
Valerie Canavin, Compliance Director
(215) 563-0652
Addresses
Street Address
1348 BAINBRIDGE STREET
PHILADELPHIA, PA 19147
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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3/5/12 added NPI #; 1/15/08 ADDR UPDATE (WAS 1201 CHESTNUT ST, 3RD FLOOR); 4/27/06 CHANGED NAME (WAS PHILA COMM HEALTH ALTERNATIVES)
03/05/2012
1/15/08 ADDR UPDATE (WAS 1201 CHESTNUT ST, 3RD FLOOR); 4/27/06 CHANGED NAME (WAS PHILA COMM HEALTH ALTERNATIVES)
02/18/2010
June 2025
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