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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390097 Holy Redeemer Hospital
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Covered Entity Details
Entity Name
Holy Redeemer Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390097
Entity Address
1648 Huntingdon Pike
Meadowbrook, PA 19046
Medicare Provider Number
390097
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02156
5843-45 RISING SUN AVENUE
PHILADELPHIA, PA 19120
Pharmacy Comments
Contract Details
Approval Date
5/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Keen, EVP and CFO
(215) 856-1114
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
5/4/2023
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