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SUNRAY DRUGS 56TH AND MARKET STREETS
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
SUNRAY DRUGS 56TH AND MARKET STREETS
Pharmacy Address
5537 MARKET ST
PHILADELPHIA, PA 19139
Pharmacy Comments
Contract Details
Approval Date
10/2/2014
Contract Begin Date
1/1/2015
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
Donald Shenk, CFO
(610) 237-4672
Contract Pharmacy Representative
Evan Stoudt, Owner
(215) 474-1700
Signed By Date
10/2/2014
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