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PENNSYLVANIA CVS PHARMACY, L.L.C.
CHC26634-00 PHILADELPHIA FIGHT
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Covered Entity Details
Entity Name
PHILADELPHIA FIGHT
Subdivision Name
Philadelphia FIGHT Jonathan Lax Treatment Center
Type
HRSA-Funded Health Center
340B ID
CHC26634-00
Entity Address
1233 Locust Street Floor 5, Suite 500 and Floor 4, Suite 400
Philadelphia, PA 19107-5453
Grant Number
H80CS26634
Participating Start Date
4/1/2014
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #11371
1717 NORTH 12TH STREET, UNIT F
PHILADELPHIA, PA 19122
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Benitez, CEO
(215) 985-4448
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2025
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