Contract Pharmacy Details

PENNSYLVANIA CVS PHARMACY, L.L.C.
FP191071 MAZZONI CENTER

Covered Entity Details

Entity Name

MAZZONI CENTER

Subdivision Name

Type

Family Planning (Title X only)

340B ID

FP191071

Entity Address

1348 BAINBRIDGE STREET
PHILADELPHIA, PA 19147

Grant Number

FPHPA006433

Participating Start Date

4/1/2003

Last Recertification Date

5/17/2023

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02583
421 SOUTH SECOND ST.
PHILADELPHIA, PA 19147

Pharmacy Comments

Contract Details

Approval Date

10/8/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/16/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Ronald Powers, COO
(215) 563-0652 Ext: 210

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/8/2018

340B Drug Pricing Program Database