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K & K RX SERVICES, LP
DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390174
Entity Address
111 South 11th Street
Philadelphia, PA 19107
Medicare Provider Number
390174
Participating Start Date
4/1/2006
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
K & K RX SERVICES, LP
Pharmacy Address
BIOMATRIX SPECIALTY PHARMACY PA
3070 MCCANN FARM DR STE 101
GARNET VALLEY, PA 19060
Pharmacy Comments
Contract Details
Approval Date
10/6/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NEIL G. LUBARSKY, SR VP FOR FINANCE
(215) 955-9993
Contract Pharmacy Representative
Elwyn Specialty Care
Nicholas Karalis, Owner
(866) 317-0672 Ext: 206
Signed By Date
10/6/2017
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