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866 EAST TREMONT PHARMACY LLC
RWI63108 DOORWAYS
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Covered Entity Details
Entity Name
DOORWAYS
Subdivision Name
Type
Ryan White Part A
340B ID
RWI63108
Entity Address
4385 Maryland Ave.
Saint Louis, MO 63108
Grant Number
H89HA00033
Participating Start Date
10/1/2020
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
866 EAST TREMONT PHARMACY LLC
Pharmacy Address
BOCA PHARMACY
864B E TREMONT AVE
BRONX, NY 10460
Pharmacy Comments
Contract Details
Approval Date
8/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Opal Michelle Jones, President & CEO
(314) 328-2701
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
8/12/2020
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