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FQ91 PHILADELPHIA, CITY OF (Terminated)
Main Details
Name
PHILADELPHIA, CITY OF
Subdivision Name
Philadelphia District Health Center #6
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009828
340B ID
FQ91
Grant Number
LALCS00084
Contacts
Authorizing Official
City of Philadelphia
Cheryl L. Kramer, Acting Director of Ambulatory Health
(215) 685-6406
Primary Contact
City of Philadelphia Dept of Public Health
Jeffrey T. Pender, Director of Pharmaceutical Services
(215) 685-6864
Additional Details
Current Program Status
Terminated
Registration Date
1/1/1994
Participating Start Date
1/1/1994
Participating Approval Date
1/1/1994
Last Recertification Date
2/3/2021
Termination Date
7/1/2021
Termination Reason
Change of covered entity type (non-hospital)
Addresses
Street Address
321 W Girard Ave
Philadelphia, PA 19123-1531
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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