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161 ST PHARMA INC
CH02426A BronxCare Health Integrated Services System, Inc.
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Covered Entity Details
Entity Name
BronxCare Health Integrated Services System, Inc.
Subdivision Name
BronxCare Dr. Martin Luther King, Jr. Health Center
Type
HRSA-Funded Health Center
340B ID
CH02426A
Entity Address
1265 Franklin Avenue
BRONX, NY 10456-3501
Grant Number
H80CS00625
Participating Start Date
7/1/2007
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
161 ST PHARMA INC
Pharmacy Address
DBA-161 ST PHARMACY & SURGICAL SUPPLIES
275 E 161ST ST
BRONX, NY 10451-3504
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LIONEL P. STEWART, EXECUTIVE DIRECTOR
(718) 466-6072
Contract Pharmacy Representative
Ravi Rx
Ravi Annamaneni, Pharmacy Owner
(848) 218-3530
Signed By Date
10/8/2018
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