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FAIRMOUNT PHARMACY INC
CH03167J PUBLIC HEALTH MANAGEMENT CORPORATION
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Covered Entity Details
Entity Name
PUBLIC HEALTH MANAGEMENT CORPORATION
Subdivision Name
PHMC Care Clinic
Type
HRSA-Funded Health Center
340B ID
CH03167J
Entity Address
1200 Callowhill St
Philadelphia, PA 19123-3658
Grant Number
H80CS00016
Participating Start Date
10/1/2010
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
FAIRMOUNT PHARMACY INC
Pharmacy Address
1900 GREEN ST
PHILADELPHIA, PA 19130
Pharmacy Comments
Contract Details
Approval Date
10/1/2010
Contract Begin Date
10/1/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
GERARD VOLGRAF, VICE PRESIDENT
(215) 567-0364
Signed By Date
8/11/2010
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