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NORTH PHILLY PHARMACY
FP191239 Bebashi Transition to Hope
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Covered Entity Details
Entity Name
Bebashi Transition to Hope
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP191239
Entity Address
1237 Spring Garden Street
Philadelphia, PA 19123
Grant Number
FPHPA006433
Participating Start Date
1/1/2021
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
NORTH PHILLY PHARMACY
Pharmacy Address
118 DIAMOND ST
PHILADELPHIA, PA 19122
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sebrina Tate, Director of Programs and Administration
(215) 769-3561 Ext: 2157693561
Contract Pharmacy Representative
North Philly Pharmacy
Kathleen Goldberg, President
(215) 763-7080
Signed By Date
7/14/2021
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