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TOMPKINSVILLE PHARMACY INC
CH021510 Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
Sun River Health Peekskill
Type
HRSA-Funded Health Center
340B ID
CH021510
Entity Address
1037 Main St
Peekskill, NY 10566-2913
Grant Number
H80CS00313
Participating Start Date
12/1/1992
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
TOMPKINSVILLE PHARMACY INC
Pharmacy Address
GANGADIN, ESAR
45 VICTORY BLVD.
STATEN ISLAND, NY 10301
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
Tompkinsville Pharmacy
Esar Gangadin, Owner
(718) 727-0430
Signed By Date
10/15/2018
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