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LEROY PHARMACY II LLC
FQHCLA334AD NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
Segundo Ruiz Belvis Diagnostic and Treatment Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA334AD
Entity Address
545 E 142nd St
Bronx, NY 10454-2110
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
2/8/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
LEROY PHARMACY II LLC
Pharmacy Address
239 E 198TH ST
BRONX, NY 10458-3147
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Leroy Pharmacy II
Kal Shah, POC
(718) 220-7600
Signed By Date
7/17/2018
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