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PELHAM PHARMACY
STD191365 Philadelphia Department of Prisons
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Covered Entity Details
Entity Name
Philadelphia Department of Prisons
Subdivision Name
Alternative and Special Detention
Type
Sexually Transmitted Diseases
340B ID
STD191365
Entity Address
8101 State Road
Philadelphia, PA 19136
Grant Number
H25PS005145
Participating Start Date
1/1/2024
Last Recertification Date
5/11/2024
Entity Termination Date
4/1/2025
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
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Bruce W Herdman, Chief of Medical Operations
(215) 400-1580
Contract Pharmacy Representative
Timi Pharmaceuticals, inc
Idayat Adewunmi, President and Chief Pharmacist
(215) 848-0500 Ext: 3475744754
Signed By Date
7/3/2024
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