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866 EAST TREMONT PHARMACY LLC
RWII06850 Mid Fairfield AIDS Project
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Covered Entity Details
Entity Name
Mid Fairfield AIDS Project
Subdivision Name
Type
Ryan White Part B
340B ID
RWII06850
Entity Address
618 West Avenue
Norwalk, CT 06850
Grant Number
X07HA00022
Participating Start Date
1/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
866 EAST TREMONT PHARMACY LLC
Pharmacy Address
BOCA PHARMACY
864B E TREMONT AVE
BRONX, NY 10460
Pharmacy Comments
Contract Details
Approval Date
4/4/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart Lane, Executive Director
(203) 855-9535
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
4/4/2019
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