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866 EAST TREMONT PHARMACY LLC
RWII065111 Hispanic Health Council, Inc.
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Covered Entity Details
Entity Name
Hispanic Health Council, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII065111
Entity Address
165 Miller St. Meriden
Meriden, CT 06450
Grant Number
X07HA202200812
Participating Start Date
4/1/2016
Last Recertification Date
2/25/2025
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
10/3/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carlos Rivera, Director of Behavioral Health and Operations
(203) 781-0226 Ext: 1106
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
10/3/2019
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