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866 EAST TREMONT PHARMACY LLC
STD349501 In the Image of Christ
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Covered Entity Details
Entity Name
In the Image of Christ
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD349501
Entity Address
707 North 7th St.
Fort Pierce, FL 34950
Grant Number
NH25PS005131
Participating Start Date
4/1/2021
Last Recertification Date
5/9/2024
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
2/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hazel Hoylman, Executive Director
(772) 461-7788 Ext: 109
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
1/14/2021
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