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59 STREET RX INC.
CH021887R SUNSET PARK HEALTH COUNCIL, INC.
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Covered Entity Details
Entity Name
SUNSET PARK HEALTH COUNCIL, INC.
Subdivision Name
WOMEN INFANTS CHILDREN FAMILY HEALTH CENTER at NYU LANGONE
Type
HRSA-Funded Health Center
340B ID
CH021887R
Entity Address
5610 Second Avenue
Brooklyn, NY 11220
Grant Number
H80CS07914
Participating Start Date
10/1/2012
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
59 STREET RX INC.
Pharmacy Address
5816 4TH AVE
BROOKLYN, NY 11220-3810
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry K. McReynolds, Executive Director
(718) 630-7216
Contract Pharmacy Representative
59 Street Rx, Inc.
Sri Charan Gummadi, Owner
(718) 567-0019
Signed By Date
7/11/2019
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