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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 #11780
2655 SOUTH TENTH ST.
PHILADELPHIA, PA 19148
Pharmacy Comments
Contract Details
Approval Date
10/1/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nicholas Chaban, CFO
(215) 563-0652
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/1/2014
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