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SUN RAY DRUG, LLC
DSH390156D MERCY CATHOLIC MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY CATHOLIC MEDICAL CENTER
Subdivision Name
Adult Ambulatory Clinic, Suite 2000 of the Sister Marie Lenahan Wellness Center
Type
Disproportionate Share Hospital
340B ID
DSH390156D
Entity Address
1503 LANSDOWNE AVENUE
Suite 2000
DARBY, PA 19023
Medicare Provider Number
390156
Outpatient Facility Provider Number
Participating Start Date
9/9/2005
Last Recertification Date
8/14/2024
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
1/24/2017
Business decision by covered entity and/or pharmacy
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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