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RW424852 Mazzoni Center (Terminated)
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Main Details
Name
Mazzoni Center
Subdivision Name
Mazzoni Annex
Type
Ryan White Part D
340B ID
RW424852
Grant Number
H12HA24852
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2016
Participating Start Date
10/1/2016
Participating Approval Date
7/22/2016
Last Recertification Date
1/27/2017
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
Mazzoni Center
Ronald Powers, COO
(215) 563-0652 Ext: 210
Primary Contact
Rob Winn, Medical Director
(215) 563-0658
Addresses
Street Address
253 South 10th Street
Philadelphia, PA 19107
Billing Address
Mazzoni Center
809 Locust Street
Philadelphia, PA 19107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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