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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390329 EINSTEIN MEDICAL CENTER MONTGOMERY
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Covered Entity Details
Entity Name
EINSTEIN MEDICAL CENTER MONTGOMERY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390329
Entity Address
559 WEST GERMANTOWN PIKE
EAST NORRITON, PA 19403
Medicare Provider Number
390329
Participating Start Date
7/1/2016
Last Recertification Date
8/20/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05898
2801 EGYPT RD.
AUDUBON, PA 19403
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
5/3/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Beth Duffy, Chief Operating Officer
(484) 622-7004
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2021
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