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PENNSYLVANIA CVS PHARMACY, L.L.C.
STD19153 Courage Medicine Health Center, Inc
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Covered Entity Details
Entity Name
Courage Medicine Health Center, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD19153
Entity Address
3751 Island Ave
201
Philadelphia, PA 19153
Grant Number
NH25PS005233-01-00
Participating Start Date
1/1/2024
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11356
3401 ARAMINGO AVENUE
PHILADELPHIA, PA 19134
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2025
Agreement registered in error
Contacts
Covered Entity Signing Official
Trisha Acri, Finance Director/Medical Director
(215) 990-7853
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2025
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