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PHARMACY OF AMERICA V
CH033200 GREATER PHILADELPHIA HEALTH ACTION, INCORPORATED
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Covered Entity Details
Entity Name
GREATER PHILADELPHIA HEALTH ACTION, INCORPORATED
Subdivision Name
Carl Moore Health Center
Type
HRSA-Funded Health Center
340B ID
CH033200
Entity Address
1401 S. 31st Street
Philadelphia, PA 19146
Grant Number
H80CS00708
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PHARMACY OF AMERICA V
Pharmacy Address
232 W. GIRARD AVE
PHILADELPHIA, PA 19123
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Clark, CEO
(215) 925-2400 Ext: 1060
Contract Pharmacy Representative
Pharmacy of America
Sabri Ibrahim, President and CEO
(215) 744-0300
Signed By Date
1/15/2020
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