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EAST GOSHEN PHARMACY, LLC
DSH390180 Crozer Chester Medical Center
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Covered Entity Details
Entity Name
Crozer Chester Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390180
Entity Address
One Medical Center Blvd
Upland, PA 19013-3995
Medicare Provider Number
390180
Participating Start Date
4/1/2012
Last Recertification Date
8/11/2015
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
EAST GOSHEN PHARMACY, LLC
Pharmacy Address
DBA BIOSCRIP INFUSION SERVICES
970 RITTENHOUSE RD STE 200
AUDUBON, PA 19403
Pharmacy Comments
Contract Details
Approval Date
10/10/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Philip J. Ryan, Senior VP & CFO
(610) 338-8228
Contract Pharmacy Representative
Dana Soper, CEO
(513) 891-6666
Signed By Date
10/10/2013
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