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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390142 ALBERT EINSTEIN MEDICAL CENTER
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Covered Entity Details
Entity Name
ALBERT EINSTEIN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390142
Entity Address
5501 OLD YORK ROAD
PHILADELPHIA, PA 19141
Medicare Provider Number
390142
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02156
5843-45 RISING SUN AVENUE
PHILADELPHIA, PA 19120
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
5/3/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
GERARD BLANEY, CHIEF FINANCIAL OFFICER
(215) 456-6020
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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