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866 EAST TREMONT PHARMACY LLC
STD80206 The Empowerment Program
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Covered Entity Details
Entity Name
The Empowerment Program
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD80206
Entity Address
1600 York St. #101
Denver, CO 80206
Grant Number
NH2PS005164
Participating Start Date
10/1/2024
Last Recertification Date
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
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
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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