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PELHAM PHARMACY
STD191364 Philadelphia Department of Prisons
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Covered Entity Details
Entity Name
Philadelphia Department of Prisons
Subdivision Name
Philadelphia Industrial Corrections Center
Type
Sexually Transmitted Diseases
340B ID
STD191364
Entity Address
8301 State Road
Philadelphia, PA 19136
Grant Number
NU62PS924826
Participating Start Date
10/1/2020
Last Recertification Date
5/19/2025
Pharmacy Details
Pharmacy Name
PELHAM PHARMACY
Pharmacy Address
TIMI PHARMACEUTICALS, INC DBA PELHAM PHA
6555 GREENE ST STE 3
PHILADELPHIA, PA 19119
Pharmacy Comments
Contract Details
Approval Date
8/19/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bruce W Herdman, Chief of Medical Operations
(215) 400-1580
Contract Pharmacy Representative
Timi Pharmaceuticals, inc
Idayat Adewunmi, President and Chief Pharmacist
(215) 848-0500 Ext: 3475744754
Signed By Date
7/7/2020
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