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866 EAST TREMONT PHARMACY LLC
RWII80206 The Empowerment Program
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Covered Entity Details
Entity Name
The Empowerment Program
Subdivision Name
Type
Ryan White Part B
340B ID
RWII80206
Entity Address
1600 York St. #101
Denver, CO 80206
Grant Number
X07HA00056
Participating Start Date
10/1/2019
Last Recertification Date
2/19/2025
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
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie Kiehl, Executive Director
(303) 320-1989
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
1/7/2020
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