Contract Pharmacy Details

SAI RX MART LLC
CHC16639-02 COMMUNITY HEALTH CENTER OF RICHMOND, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTER OF RICHMOND, INC.

Subdivision Name

CHCR - 135 Canal St, 3rd Floor

Type

HRSA-Funded Health Center

340B ID

CHC16639-02

Entity Address

135 CANAL ST
STATEN ISLAND, NY 10304-2059

Grant Number

H80CS16639

Participating Start Date

7/1/2016

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

SAI RX MART LLC

Pharmacy Address

DBA-MILLERS PHARMACY
173 BROAD ST
STATEN ISLAND, NY 10304

Pharmacy Comments

Contract Details

Approval Date

10/11/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Benito Lindo, CFO
(718) 924-2254 Ext: 7414

Contract Pharmacy Representative

Miller's Pharmacy
Trivikram Kanumuri, Owner
(718) 447-4127

Signed By Date

10/11/2018

340B Drug Pricing Program Database