Contract Pharmacy Details

PENNSYLVANIA CVS PHARMACY, L.L.C.
CH03414A SPECTRUM HEALTH SERVICES, INC.

Covered Entity Details

Entity Name

SPECTRUM HEALTH SERVICES, INC.

Subdivision Name

BROAD STREET HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH03414A

Entity Address

1415 N Broad St STE 224
Philadelphia, PA 19122-3325

Grant Number

H80CS00389

Participating Start Date

10/1/2016

Last Recertification Date

2/13/2025

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

4/9/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Shawna L Russell-Young, Chief Compliance Officer
(215) 668-0847

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/9/2025

340B Drug Pricing Program Database