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EINSTEIN AT CENTER ONE PHARMACY
DSH390115 Jefferson Health Northeast
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Covered Entity Details
Entity Name
Jefferson Health Northeast
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390115
Entity Address
10800 Knights Rd.
PHILADELPHIA, PA 19114
Medicare Provider Number
390115
Participating Start Date
10/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
EINSTEIN AT CENTER ONE PHARMACY
Pharmacy Address
9880 BUSTLETON AVE STE 305
PHILADELPHIA, PA 19115-2144
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
10/20/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CARRIE FREY, Director of Finance
(215) 612-4313
Contract Pharmacy Representative
Einstein Healthcare Network
Deborah Hauser, Director, Pharmacy Services
(215) 456-6486
Signed By Date
10/14/2021
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