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NORTH PHILLY PHARMACY
STD19123 Bebashi - Transition to Hope
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Covered Entity Details
Entity Name
Bebashi - Transition to Hope
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD19123
Entity Address
1235 Spring Garden Street
Philadelphia, PA 19123
Grant Number
6 NU62PS924728-03-04
Participating Start Date
1/1/2016
Last Recertification Date
5/5/2025
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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