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PENNSYLVANIA CVS PHARMACY, L.L.C.
CH03414C SPECTRUM HEALTH SERVICES
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Covered Entity Details
Entity Name
SPECTRUM HEALTH SERVICES
Subdivision Name
Cottman Avenue Health Center
Type
HRSA-Funded Health Center
340B ID
CH03414C
Entity Address
3525 Cottman Ave
Philadelphia, PA 19149-1607
Grant Number
H80CS00389
Participating Start Date
4/1/2023
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02755
4314 LOCUST STREET
PHILADELPHIA, PA 19104
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shawna L Russell-Young, Chief Compliance Officer
(215) 668-0847
Contract Pharmacy Representative
CVS Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
10/5/2023
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