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523 PHARMACY CORP.
HV022690 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
SYDENHAM HEALTH CARE NETWORK
Type
Ryan White Part C
340B ID
HV022690
Entity Address
264 W 118th St
NEW YORK, NY 10026
Grant Number
H76HA00034
Participating Start Date
12/1/1992
Last Recertification Date
2/8/2018
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
523 PHARMACY CORP.
Pharmacy Address
523 MALCOLM X BLVD
NEW YORK, NY 10037
Pharmacy Comments
Contract Details
Approval Date
1/19/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
523 PHARMACY CORP
Amin Chaudry, Owner
(212) 281-7408
Signed By Date
1/19/2017
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