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PELHAM PHARMACY
DSH390027 TEMPLE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
TEMPLE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390027
Entity Address
3401 North Broad Street
PHILADELPHIA, PA 19140
Medicare Provider Number
390027
Participating Start Date
1/1/2004
Last Recertification Date
8/17/2024
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
10/27/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert H. Lux, Vice President, Chief Financial Officer & Treasurer
(215) 707-3802
Contract Pharmacy Representative
Timi Pharmaceuticals, inc
Idayat Adewunmi, President and Chief Pharmacist
(215) 848-0500 Ext: 3475744754
Signed By Date
10/27/2016
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