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GLENDALE PRESCRIPTION CENTER
DSH390025 Kensington Hospital
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Covered Entity Details
Entity Name
Kensington Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390025
Entity Address
136 W. Diamond Street
Philadelphia, PA 19122
Medicare Provider Number
390025
Participating Start Date
7/1/2013
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
GLENDALE PRESCRIPTION CENTER
Pharmacy Address
GLENDALE PRESCRIPTION CENTER
7601 CASTOR AVE STE 100
PHILADELPHIA, PA 19152-4028
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen Lalli, Chief Executive Officer
(215) 426-8100 Ext: 6502
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
4/16/2018
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