340B Drug Pricing Program Database

Pharmacy Name

JAC PHARMACY INC

Pharmacy Address

.
93-15 ROOSEVELT AVE
JACKSON HEIGHTS, NY 11372

Pharmacy Comments

Approval Date

11/7/2012

Contract Begin Date

10/27/2012

Carve-In Effective Date

Contract Comments

11/05/2012 - public health emergency declared in the state of NY effective 10/27/2012

Contract Termination Date
Termination Reason

11/25/2017
Business decision by covered entity and/or pharmacy

Covered Entity Signing Official

Teresita R. Rodriguez, CEO
(212) 334-7940 Ext: 5377

Contract Pharmacy Representative

National Rx Pharma
Jose Campon, President
(516) 523-6948

Signed By Date

10/9/2012