Contract Pharmacy Details

PELHAM PHARMACY
RWI19133 Prevention Point Philadelphia

Covered Entity Details

Entity Name

Prevention Point Philadelphia

Subdivision Name

Type

Ryan White Part A

340B ID

RWI19133

Entity Address

2913-15 Kensington Avenue
Philadelphia, PA 19134

Grant Number

H89HA00013

Participating Start Date

7/1/2013

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

PELHAM PHARMACY

Pharmacy Address

TIMI PHARMACEUTICALS, INC DBA PELHAM PHA
6555 GREENE ST STE 3
PHILADELPHIA, PA 19119

Pharmacy Comments

Contract Details

Approval Date

7/12/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Anne Kelly, Medical Services Sustainability Manager
(215) 589-5555

Contract Pharmacy Representative

Timi Pharmaceuticals
Idayat Adewunmi, CEO/President
(347) 574-4754

Signed By Date

7/12/2022

340B Drug Pricing Program Database