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FAIRMOUNT PHARMACY INC
CH03167A PUBLIC HEALTH MANAGEMENT CORPORATION
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Covered Entity Details
Entity Name
PUBLIC HEALTH MANAGEMENT CORPORATION
Subdivision Name
MARY HOWARD HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH03167A
Entity Address
125 S 9th St
Philadelphia, PA 19107-5125
Grant Number
H80CS00016
Participating Start Date
7/1/2004
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
FAIRMOUNT PHARMACY INC
Pharmacy Address
1900 GREEN ST
PHILADELPHIA, PA 19130
Pharmacy Comments
Contract Details
Approval Date
1/10/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Cohen, President and CEO
(215) 985-2501
Contract Pharmacy Representative
GERARD VOLGRAF, VICE PRESIDENT
(215) 567-0364
Signed By Date
1/10/2016
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