Contract Pharmacy Details

BERGENLINE DRUGS
CH024490 NORTH HUDSON COMMUNITY ACTION CORPORATION

Covered Entity Details

Entity Name

NORTH HUDSON COMMUNITY ACTION CORPORATION

Subdivision Name

North Hudson Community Action Corporation @ West New York

Type

HRSA-Funded Health Center

340B ID

CH024490

Entity Address

5301 BROADWAY
WEST NEW YORK, NJ 07093-2622

Grant Number

H80CS00521

Participating Start Date

1/1/2004

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

BERGENLINE DRUGS

Pharmacy Address

4923 BERGENLINE AVE
WEST NEW YORK, NJ 07093-5510

Pharmacy Comments

Contract Details

Approval Date

10/25/2012

Contract Begin Date

10/25/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/8/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Christopher Irizarry, President/CEO
(201) 210-0100

Contract Pharmacy Representative

Carlos Almanza, Pharmacist in Charge
(201) 867-0615

Signed By Date

9/21/2012

340B Drug Pricing Program Database