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PHILADELPHIA PHARMACY
CHC26634-04 Philadelphia FIGHT
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Covered Entity Details
Entity Name
Philadelphia FIGHT
Subdivision Name
Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26634-04
Entity Address
1207 Chestnut Street Fl 4 and 5
Philadelphia, PA 19107-4131
Grant Number
H80CS26634
Participating Start Date
7/1/2018
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
12/30/2022
Pharmacy closed
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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