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MEDLY PHARMACY INC.
CH028480 DAMIAN FAMILY CARE CENTERS, INC.
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Covered Entity Details
Entity Name
DAMIAN FAMILY CARE CENTERS, INC.
Subdivision Name
DBA PROJECT SAMARITAN HEALTH SERVICES
Type
HRSA-Funded Health Center
340B ID
CH028480
Entity Address
13750 Jamaica Ave
Jamaica, NY 11435-3610
Grant Number
H80CS01765
Participating Start Date
9/4/2008
Last Recertification Date
2/12/2025
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
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Peter Grisafi, CEO
(718) 657-1100 Ext: 1225
Contract Pharmacy Representative
Medly Pharmacy
Jitendra Patel, Pharmacy Director
(718) 782-7539
Signed By Date
10/14/2020
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