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MEDFORD CHEMISTS INC
CH02151BC Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
Advantage Care Diagnostic and Treatment Center Freeport
Type
HRSA-Funded Health Center
340B ID
CH02151BC
Entity Address
230 Hanse Avenue
Freeport, NY 11520
Grant Number
H80CS00313
Participating Start Date
1/1/2016
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MEDFORD CHEMISTS INC
Pharmacy Address
2608 ROUTE 112
MEDFORD, NY 11763
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
Medford Chemists
Rajan Vohora, CEO
(631) 475-4476
Signed By Date
4/12/2019
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