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ELWYN PHARMACY
HV00553A Philadelphia FIGHT - Clinica Bienestar
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Covered Entity Details
Entity Name
Philadelphia FIGHT - Clinica Bienestar
Subdivision Name
Type
Ryan White Part C
340B ID
HV00553A
Entity Address
2913-15 Kensington Ave
Philadelphia, PA 19134
Grant Number
H76HA00553
Participating Start Date
4/1/2014
Last Recertification Date
3/5/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
ELWYN PHARMACY
Pharmacy Address
194 S MIDDLETOWN ROAD
ELWYN, PA 19063-5202
Pharmacy Comments
Contract Details
Approval Date
7/7/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JANE SHULL, EXECUTIVE DIRECTOR
(215) 985-4448 Ext: 102
Contract Pharmacy Representative
Nick Karalis, President
(866) 317-0672
Signed By Date
7/7/2016
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