Contract Pharmacy Details

PICKWICK PHARMACY
CH031670 PUBLIC HEALTH MANAGEMENT CORPORATION

Covered Entity Details

Entity Name

PUBLIC HEALTH MANAGEMENT CORPORATION

Subdivision Name

Public Health Management Corporation

Type

HRSA-Funded Health Center

340B ID

CH031670

Entity Address

Centre Square East
1500 Market Street
Philadelphia, PA 19102-2100

Grant Number

H80CS00016

Participating Start Date

7/1/2004

Last Recertification Date

2/28/2025

Pharmacy Details

Pharmacy Name

PICKWICK PHARMACY

Pharmacy Address

1700 MARKET ST
PHILADELPHIA, PA 19103

Pharmacy Comments

Contract Details

Approval Date

7/14/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/30/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Richard Cohen, President and CEO
(215) 985-2501

Contract Pharmacy Representative

Pickwick Pharmacy Inc.
Nasir Fahhan, Owner
(215) 563-4860

Signed By Date

7/14/2020

340B Drug Pricing Program Database