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TEMPLE UNIVERSITY HOSPITAL OUTPATIENT PH
RWI19125A Temple University Of The Commonwealth System of Higher Education
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Covered Entity Details
Entity Name
Temple University Of The Commonwealth System of Higher Education
Subdivision Name
Temple General Internal Medicine Associates
Type
Ryan White Part A
340B ID
RWI19125A
Entity Address
1316 West Ontario Street
1st Floor Jones Hall
Philadelphia, PA 19140
Grant Number
H89HA00013
Participating Start Date
4/1/2017
Last Recertification Date
1/30/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
TEMPLE UNIVERSITY HOSPITAL OUTPATIENT PH
Pharmacy Address
TEMPLE UNIVERSITY HOSPITAL INC.
3401 N BROAD ST
B150
PHILADELPHIA, PA 19140
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas Kupp, Executive Director of TUP
(215) 707-7292
Contract Pharmacy Representative
Temple University Health System
Warren richard Robinson, Director of Outpatient Pharmacy Services
(215) 707-3181
Signed By Date
4/4/2017
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