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HV00553A Philadelphia FIGHT - Clinica Bienestar (Terminated)
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Main Details
Name
Philadelphia FIGHT - Clinica Bienestar
Subdivision Name
Type
Ryan White Part C
340B ID
HV00553A
Grant Number
H76HA00553
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/12/2014
Last Recertification Date
3/5/2018
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Philadelphia FIGHT
JANE SHULL, EXECUTIVE DIRECTOR
(215) 985-4448 Ext: 102
Primary Contact
Philadelphia FIGHT
Dan Clemons, Chief Financial Officer
(215) 985-4448 Ext: 106
Addresses
Street Address
2913-15 Kensington Ave
Philadelphia, PA 19134
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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3/12/14 Clinic Site is sub recipient to Philadelphia Fight
03/12/2014
June 2025
June 2025
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