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3817 BROADWAY PHARMACY INC
CH021630 COMMUNITY HEALTHCARE NETWORK
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Covered Entity Details
Entity Name
COMMUNITY HEALTHCARE NETWORK
Subdivision Name
COMMUNITY HEALTHCARE NETWORK
Type
HRSA-Funded Health Center
340B ID
CH021630
Entity Address
60 MADSION AVE
5TH FLOOR
NEW YORK, NY 10010
Grant Number
H80CS00597
Participating Start Date
10/1/2001
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
3817 BROADWAY PHARMACY INC
Pharmacy Address
3835 BROADWAY
NEW YORK, NY 10032
Pharmacy Comments
DBA VIM DRUGS according to owner(not shown on DEA license)
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/2/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alan Wengrofsky, CFO
(212) 545-2481
Contract Pharmacy Representative
Rajan Pillay, Supervising Pharmacist
(212) 927-0220
Signed By Date
7/14/2015
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