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866 EAST TREMONT PHARMACY LLC
RWI20001 Community Family Life Services
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Covered Entity Details
Entity Name
Community Family Life Services
Subdivision Name
Type
Ryan White Part A
340B ID
RWI20001
Entity Address
305 E St NW
Washington, DC 20001
Grant Number
H89HA00012
Participating Start Date
7/1/2021
Last Recertification Date
2/25/2022
Entity Termination Date
4/1/2023
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
5/4/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ashley McSwain, Executive Director
(202) 347-0511 Ext: 3013952170
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
4/13/2021
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