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SUN RAY DRUG, LLC
DSH390156A MERCY CATHOLIC MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY CATHOLIC MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390156A
Entity Address
501 South 54th
ATTN: CHIEF FINANCIAL OFFICER
Philadelphia, PA 19143
Medicare Provider Number
390156
Outpatient Facility Provider Number
Participating Start Date
7/1/2003
Last Recertification Date
8/30/2019
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
SUN RAY DRUG, LLC
Pharmacy Address
142 S 52ND STREET
PHILADELPHIA, PA 19139
Pharmacy Comments
Contract Details
Approval Date
7/17/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/15/2017
Other
Contacts
Covered Entity Signing Official
JOSEPH H. BRADLEY, CFO
(610) 567-6770
Contract Pharmacy Representative
Sunray
Marcus Tancredi, Director of Pharmacy
(215) 474-4615
Signed By Date
7/17/2013
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