Contract Pharmacy Details

PRXP OF NEW YORK LLC
RWII93401B Access Support Network

Covered Entity Details

Entity Name

Access Support Network

Subdivision Name

Monterey

Type

Ryan White Part B

340B ID

RWII93401B

Entity Address

Montage Medical Group Ryan Ranch Campus
2 Upper Ragsdale Dr. Building A
Monterey, CA 93940

Grant Number

X07HA10954

Participating Start Date

5/8/2023

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

PRXP OF NEW YORK LLC

Pharmacy Address

DBA BROADWAY FAMILY PHARMACY
601 AMSTERDAM AVE
NEW YORK, NY 10024

Pharmacy Comments

Contract Details

Approval Date

2/20/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

David Kilburn, Executive Director
(805) 781-3660 Ext: 212

Contract Pharmacy Representative

Physicians Rx Pharmacy of Clinton
Chris Wakefield, Manager
(412) 357-5163

Signed By Date

1/17/2020

340B Drug Pricing Program Database