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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390142 ALBERT EINSTEIN MEDICAL CENTER
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Covered Entity Details
Entity Name
ALBERT EINSTEIN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390142
Entity Address
5501 OLD YORK ROAD
PHILADELPHIA, PA 19141
Medicare Provider Number
390142
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01193
835 OLD YORK ROAD
JENKINTOWN, PA 19046
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
1/30/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Walter Wyatt, VP-Finance
(215) 254-3254
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2023
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