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WALGREEN EASTERN CO INC
CH032900 DELAWARE VALLEY COMMUNITY HEALTH, INC.
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Covered Entity Details
Entity Name
DELAWARE VALLEY COMMUNITY HEALTH, INC.
Subdivision Name
Fairmount Primary Care Center
Type
HRSA-Funded Health Center
340B ID
CH032900
Entity Address
1412-22 FAIRMOUNT AVENUE
PHILADELPHIA, PA 19130-2908
Grant Number
H80CS00833
Participating Start Date
1/1/2003
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO INC
Pharmacy Address
DBA: WALGREENS # 04115
4201 N BROAD ST
PHILADELPHIA, PA 19140
Pharmacy Comments
Contract Details
Approval Date
7/15/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/30/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
PATRICIA DEITCH, CEO
(215) 684-5344
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2013
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