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SOLVENCY HEALTH PHARMACY
STD191022 Philadelphia AIDS Consortium
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Covered Entity Details
Entity Name
Philadelphia AIDS Consortium
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD191022
Entity Address
112 Broad Street
Philadelphia, PA 19102
Grant Number
5H25PS004355-02
Participating Start Date
10/1/2015
Last Recertification Date
5/20/2024
Pharmacy Details
Pharmacy Name
SOLVENCY HEALTH PHARMACY
Pharmacy Address
7 BALA AVE STE 100
BALA CYNWYD, PA 19004
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Yoshiaki Yamasaki, Executive Director
(215) 888-6080
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
10/13/2016
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