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866 EAST TREMONT PHARMACY LLC
STD63101 Community Wellness Project
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Covered Entity Details
Entity Name
Community Wellness Project
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD63101
Entity Address
906 Olive St
200
St. Louis, MO 63101
Grant Number
1 NU62PS924706-01-00
Participating Start Date
7/1/2018
Last Recertification Date
5/10/2024
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
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dana P Williams, Executive Director
(314) 421-9600
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
1/14/2020
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