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MEDLY PHARMACY INC.
CH02151BD Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
Harmony Healthcare Long Island at Roosevelt High School
Type
HRSA-Funded Health Center
340B ID
CH02151BD
Entity Address
1 WAGNER AVE
104
ROOSEVELT, NY 11575-1153
Grant Number
H80CS00313
Participating Start Date
4/1/2016
Last Recertification Date
2/24/2025
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
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/10/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
Medly Pharmacy
Jitendra Patel, Pharmacy Director
(718) 782-7539
Signed By Date
7/15/2020
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