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STAND PHARMACY
CH02360Z URBAN HEALTH PLAN, INC.
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Covered Entity Details
Entity Name
URBAN HEALTH PLAN, INC.
Subdivision Name
Elmhurst Educational Campus
Type
HRSA-Funded Health Center
340B ID
CH02360Z
Entity Address
4510 94th Street
Elmhurst, NY 11373-2824
Grant Number
H80CS00368
Participating Start Date
7/1/2019
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
STAND PHARMACY
Pharmacy Address
1515 SOUTHERN BLVD
BRONX, NY 10460
Pharmacy Comments
Contract Details
Approval Date
5/6/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paloma Hernandez, President and CEO
(718) 589-2440 Ext: 4219
Contract Pharmacy Representative
SOL'S 4 PHARMACY INC
Andrew Silverman, President
(718) 639-4107
Signed By Date
4/19/2019
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