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5TH AVENUE PHARMACY INC
CH021200 BETANCES HEALTH CENTER
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Covered Entity Details
Entity Name
BETANCES HEALTH CENTER
Subdivision Name
BETANCES HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH021200
Entity Address
280 Henry St
New York, NY 10002-4816
Grant Number
H80CS00235
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
5TH AVENUE PHARMACY INC
Pharmacy Address
4818 5TH AVE
BROOKLYN, NY 11220-1122
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julia Tsien, CEO
(212) 227-8401 Ext: 101
Contract Pharmacy Representative
5th Avenue Pharmacy
Jordan Fogel, Pharmacist
(718) 439-8585
Signed By Date
10/11/2021
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