Contract Pharmacy Details

FARMACIA SAN JOSE
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

FARMACIA SAN JOSE

Pharmacy Address

149 48TH ST
UNION CITY, NJ 07087-6428

Pharmacy Comments

Contract Details

Approval Date

4/24/2013

Contract Begin Date

7/1/2013

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

Raul Mazon, Owner
(201) 864-1809

Signed By Date

4/24/2013

340B Drug Pricing Program Database