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MEDLY PHARMACY INC.
CHC26191-06 Housing Works Health Services III, Inc.
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Covered Entity Details
Entity Name
Housing Works Health Services III, Inc.
Subdivision Name
125th Street Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26191-06
Entity Address
145 East 125th Street Fl 3-4
New York, NY 10035-2809
Grant Number
H80CS26191
Participating Start Date
7/1/2020
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MEDLY PHARMACY INC.
Pharmacy Address
DBA MEDLY PHARMACY
31 DEBEVOISE ST
BROOKLYN, NY 11206-4196
Pharmacy Comments
Contract Details
Approval Date
4/28/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia Troy, SVP, Healthcare Services
(347) 473-7458
Contract Pharmacy Representative
Medly Pharmacy
Jitendra Patel, Pharmacy Director
(718) 782-7539
Signed By Date
4/15/2020
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