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GPHA PHARMACY
CH03320G GREATER PHILADELPHIA HEALTH ACTION, INCORPORATED
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Covered Entity Details
Entity Name
GREATER PHILADELPHIA HEALTH ACTION, INCORPORATED
Subdivision Name
AL-ASSIST BEHAVIORAL HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH03320G
Entity Address
1401 S 4th St
Philadelphia, PA 19147-5907
Grant Number
H80CS00708
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GPHA PHARMACY
Pharmacy Address
5501 WOODLAND AVE.
PHILADELPHIA, PA 19143
Pharmacy Comments
Contract Details
Approval Date
6/27/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Clark, CEO
(215) 925-2400 Ext: 1060
Contract Pharmacy Representative
Greater Philadelphia Health Action
Brian Clark, CEO
(215) 925-2400 Ext: 1060
Signed By Date
6/27/2019
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