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EINSTEIN AT CENTER ONE PHARMACY
DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390174
Entity Address
111 South 11th Street
Philadelphia, PA 19107
Medicare Provider Number
390174
Participating Start Date
4/1/2006
Last Recertification Date
9/8/2024
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
Andrew Nathans, Vice president Finance, TJUH Inc.
(215) 955-6599
Contract Pharmacy Representative
Einstein Healthcare Network
Deborah Hauser, Director, Pharmacy Services
(215) 456-6486
Signed By Date
10/14/2021
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