Contract Pharmacy Details

MEDLY PHARMACY INC.
FQHCLA334U NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Covered Entity Details

Entity Name

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Subdivision Name

East New York Diagnostic and Treatment Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA334U

Entity Address

2094 Pitkin Ave
Brooklyn, NY 11207-3509

Grant Number

LALCS00169

Participating Start Date

7/1/2015

Last Recertification Date

2/22/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

MEDLY PHARMACY INC.

Pharmacy Address

DBA MEDLY PHARMACY
31 DEBEVOISE ST
BROOKLYN, NY 11206-4196

Pharmacy Comments

Contract Details

Approval Date

7/13/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/25/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

Medley Pharmacy
Marg Patel, POC
(718) 782-7539

Signed By Date

7/13/2018

340B Drug Pricing Program Database