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PHILADELPHIA PHARMACY
CHC26634-00 PHILADELPHIA FIGHT
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Covered Entity Details
Entity Name
PHILADELPHIA FIGHT
Subdivision Name
Philadelphia FIGHT Jonathan Lax Treatment Center
Type
HRSA-Funded Health Center
340B ID
CHC26634-00
Entity Address
1233 Locust Street Floor 5, Suite 500 and Floor 4, Suite 400
Philadelphia, PA 19107-5453
Grant Number
H80CS26634
Participating Start Date
4/1/2014
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PHILADELPHIA PHARMACY
Pharmacy Address
101 E LEHIGH AVENUE
PHILADELPHIA, PA 19125
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
JANE SHULL, EXECUTIVE DIRECTOR
(215) 985-4448 Ext: 102
Contract Pharmacy Representative
Philadelphia Pharmacy
Richard Ost, President
(215) 425-2800
Signed By Date
10/12/2018
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