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PENNSYLVANIA CVS PHARMACY, L.L.C.
CH03414A SPECTRUM HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
SPECTRUM HEALTH SERVICES, INC.
Subdivision Name
BROAD STREET HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH03414A
Entity Address
1415 N Broad St STE 224
Philadelphia, PA 19122-3325
Grant Number
H80CS00389
Participating Start Date
10/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02704
4849 MARKET ST.
PHILADELPHIA, PA 19139
Pharmacy Comments
Contract Details
Approval Date
4/3/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie Wroten, Chief Programs and Develop
(215) 471-2761 Ext: 3256
Contract Pharmacy Representative
CaptureRX
Joe Mast, Rite Aid Key Account Manager
(717) 214-8538
Signed By Date
4/3/2019
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