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PHARMACY OF NORRISTOWN
RWII19403A Family Service of Montgomery County PA
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Covered Entity Details
Entity Name
Family Service of Montgomery County PA
Subdivision Name
Type
Ryan White Part B
340B ID
RWII19403A
Entity Address
1976 East High Street
Pottstown, PA 19464
Grant Number
X07HA00021
Participating Start Date
7/1/2016
Last Recertification Date
2/12/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
PHARMACY OF NORRISTOWN
Pharmacy Address
420 W MARSHALL ST
NORRISTOWN, PA 19401-4640
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tim O'Connell, Dir. Special Projects
(610) 630-2111 Ext: 224
Contract Pharmacy Representative
Phamacy of Norristown
Mahesh Paladugu, President
(484) 231-1014
Signed By Date
10/14/2019
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