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EDDYSTONE COMMUNITY PHARMACY
HV01703 KENSINGTON HOSPITAL
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Covered Entity Details
Entity Name
KENSINGTON HOSPITAL
Subdivision Name
Type
Ryan White Part C
340B ID
HV01703
Entity Address
136 W. DIAMOND STREET
PHILADELPHIA, PA 19122
Grant Number
H76HA01703
Participating Start Date
10/1/2010
Last Recertification Date
2/14/2019
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
EDDYSTONE COMMUNITY PHARMACY
Pharmacy Address
1207B CHESTERPIKE
EDDYSTONE, PA 19022
Pharmacy Comments
Contract Details
Approval Date
10/7/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/29/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EILEEN HAUSE, CEO
(215) 426-8100 Ext: 6502
Contract Pharmacy Representative
AIDS Care Group
Eric Strauss, Executive Director
(610) 724-6354
Signed By Date
10/7/2015
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