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WALGREEN EASTERN CO. INC.
FP191071 MAZZONI CENTER
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Covered Entity Details
Entity Name
MAZZONI CENTER
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP191071
Entity Address
1348 BAINBRIDGE STREET
PHILADELPHIA, PA 19147
Grant Number
FPHPA006433
Participating Start Date
4/1/2003
Last Recertification Date
5/17/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO. INC.
Pharmacy Address
DBA:WALGREENS #15336
1 SOUTH BROAD STREET
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tracy Graham, Director, Family Planning Program, FAMILY PLANNING COUNCIL
(215) 755-6462 Ext: 139
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2014
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