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MEDLY PHARMACY INC.
CH021200 BETANCES HEALTH CENTER
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Covered Entity Details
Entity Name
BETANCES HEALTH CENTER
Subdivision Name
BETANCES HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH021200
Entity Address
280 Henry St
New York, NY 10002-4816
Grant Number
H80CS00235
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEDLY PHARMACY INC.
Pharmacy Address
DBA MEDLY PHARMACY
31 DEBEVOISE ST
BROOKLYN, NY 11206-4196
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Julia Tsien, CEO
(212) 227-8401 Ext: 101
Contract Pharmacy Representative
Lindenwood Rx
Nate Coney, Owner
(609) 992-9692 Ext: 7185991309
Signed By Date
1/11/2019
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