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NORTH PHILLY PHARMACY
RWI19027 Bebashi-Transition to Hope
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Covered Entity Details
Entity Name
Bebashi-Transition to Hope
Subdivision Name
Type
Ryan White Part A
340B ID
RWI19027
Entity Address
1235 Spring Garden Street
1st Floor
Philadelphia, PA 19123
Grant Number
H89HA00013
Participating Start Date
7/1/2013
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
NORTH PHILLY PHARMACY
Pharmacy Address
118 DIAMOND ST
PHILADELPHIA, PA 19122
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Bell, Executive Director
(215) 769-3561
Contract Pharmacy Representative
North Philly Pharmacy
Kathleen Goldberg, President
(215) 763-7080
Signed By Date
7/12/2018
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