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PORT RICHMOND PHARMACY
DSH390025 Kensington Hospital
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Covered Entity Details
Entity Name
Kensington Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390025
Entity Address
136 W. Diamond Street
Philadelphia, PA 19122
Medicare Provider Number
390025
Participating Start Date
7/1/2013
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
PORT RICHMOND PHARMACY
Pharmacy Address
2636-38 E ALLEGHENY AVE
PHILADELPHIA, PA 19134
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen Lalli, Chief Executive Officer
(215) 426-8100 Ext: 6502
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
7/11/2024
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