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ELMHURST RX INC
CH02426A BronxCare Health Integrated Services System, Inc.
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Covered Entity Details
Entity Name
BronxCare Health Integrated Services System, Inc.
Subdivision Name
BronxCare Dr. Martin Luther King, Jr. Health Center
Type
HRSA-Funded Health Center
340B ID
CH02426A
Entity Address
1265 Franklin Avenue
BRONX, NY 10456-3501
Grant Number
H80CS00625
Participating Start Date
7/1/2007
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
ELMHURST RX INC
Pharmacy Address
557 E 169TH ST
D/B/A FULTON CARE PHARMACY
BRONX, NY 10456-2625
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Crystal D Jordan, Executive Director
(718) 466-6072
Contract Pharmacy Representative
Elmhurst Rx, Inc.
Imram Kazmi, Chief Executive Officer
(917) 449-0086
Signed By Date
10/15/2020
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