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MAPLE RX NY LLC
FQHCLA319 COMMUNITY MEDICAL AND DENTAL CARE, INC
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Covered Entity Details
Entity Name
COMMUNITY MEDICAL AND DENTAL CARE, INC
Subdivision Name
Monsey Family Medical Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA319
Entity Address
40 Robert Pitt Dr
Monsey, NY 10952-3333
Grant Number
LALCS00146
Participating Start Date
1/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MAPLE RX NY LLC
Pharmacy Address
DBA: MAPLE PHARMACY
59 ROUTE 59 STE 143
MONSEY, NY 10952-3536
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mendel Hoffman, CEO
(845) 352-6800 Ext: 3812
Contract Pharmacy Representative
Medex
Israel Gottlieb, Pharmacist
(845) 425-3400
Signed By Date
4/14/2020
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