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866 EAST TREMONT PHARMACY LLC
CHC26585-04 Community Health Center of Northeast Oklahoma, Inc.
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Covered Entity Details
Entity Name
Community Health Center of Northeast Oklahoma, Inc.
Subdivision Name
Vinita Community Health Cetner
Type
HRSA-Funded Health Center
340B ID
CHC26585-04
Entity Address
244 S Scraper St
Vinita, OK 74301-3740
Grant Number
H80CS26585
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
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
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Janet Mendez, Chief Operating Officer
(918) 257-8029
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
7/8/2021
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