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JEFFERSON PHARMACY 1101 CHESTNUT
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
JEFFERSON PHARMACY 1101 CHESTNUT
Pharmacy Address
1101 CHESTNUT ST STE 2500
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/25/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Nathans, Vice president Finance, TJUH Inc.
(215) 955-6599
Contract Pharmacy Representative
Thomas Jefferson University Hospital
Brian G. Swift, Chief Pharmacy Officer
(215) 955-6736
Signed By Date
4/25/2024
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