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866 EAST TREMONT PHARMACY LLC
CH02360V URBAN HEALTH PLAN, INC.
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Covered Entity Details
Entity Name
URBAN HEALTH PLAN, INC.
Subdivision Name
EDDIE FERNANDEZ HOUSE
Type
HRSA-Funded Health Center
340B ID
CH02360V
Entity Address
1215 Seneca Ave
Bronx, NY 10474-4620
Grant Number
H80CS00368
Participating Start Date
10/1/2015
Last Recertification Date
2/20/2023
Entity Termination Date
10/1/2023
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
10/28/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paloma Hernandez, President and CEO
(718) 589-2440 Ext: 4219
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
10/28/2019
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