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CEDAR CARE PHARMACY
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
CEDAR CARE PHARMACY
Pharmacy Address
543 S. 52ND ST
PHILADELPHIA, PA 19143
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
6/30/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
JOSEPH H. BRADLEY, CFO
(610) 567-6770
Contract Pharmacy Representative
Uche Davis, Pharmacy Mgr
(215) 307-3334
Signed By Date
7/17/2013
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