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MAIN STREET PHARMACY
STD061141 Latino Community Services, Inc.
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Covered Entity Details
Entity Name
Latino Community Services, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD061141
Entity Address
28 Grand Street 2nd FL
Hartford, CT 06106
Grant Number
1NH25PS005155 01
Participating Start Date
7/1/2017
Last Recertification Date
5/6/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
MAIN STREET PHARMACY
Pharmacy Address
421 PARK ST
HARTFORD, CT 06106-1534
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Madeline Rodriguez, Executive Director
(860) 296-6400 Ext: 238
Contract Pharmacy Representative
Main Street Pharmacy
Raveendra Reddy Bommu, President
(860) 200-0909
Signed By Date
4/6/2021
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