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FQHCLA463 Mazzoni Center (Active)
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Main Details
Name
Mazzoni Center
Subdivision Name
Washington West
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-037665
340B ID
FQHCLA463
Grant Number
LALCS52965
Additional Details
Current Program Status
Active
Registration Date
1/5/2024
Participating Start Date
4/1/2024
Participating Approval Date
3/11/2024
Last Recertification Date
2/17/2025
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
1201 Locust St.
Philadelphia, PA 19107-5409
Billing Address
Mazzoni Center
1348 Bainbridge Street
Philadelphia, PA 19147
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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