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PERFORMSPECIALTY, LLC
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
PERFORMSPECIALTY, LLC
Pharmacy Address
2416 LAKE ORANGE DR.
STE 190
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
10/24/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Nathans, Vice president Finance, TJUH Inc.
(215) 955-6599
Contract Pharmacy Representative
Perform Specialty
Shavonda Leakes, Director of Pharmacy Operations
(407) 581-9869
Signed By Date
10/13/2022
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