Contract Pharmacy Details

MEDLY PHARMACY
CHC40174-00 IRONBOUND COMMUNITY HEALTH CENTER INC.

Covered Entity Details

Entity Name

IRONBOUND COMMUNITY HEALTH CENTER INC.

Subdivision Name

Hope & Esperanza Community Health Center

Type

HRSA-Funded Health Center

340B ID

CHC40174-00

Entity Address

788 Mount Prospect Ave Fl 2
Newark, NJ 07104-3221

Grant Number

H80CS40174

Participating Start Date

5/25/2021

Last Recertification Date

1/31/2022

Entity Termination Date

9/28/2022

Pharmacy Details

Pharmacy Name

MEDLY PHARMACY

Pharmacy Address

40 W MAIN ST
SOMERVILLE, NJ 08876

Pharmacy Comments

Contract Details

Approval Date

10/13/2021

Contract Begin Date

10/13/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/28/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Michelle Lolo, CEO
(973) 433-9773

Contract Pharmacy Representative

Medly Pharmacy Inc.
Jitu Patel, Chief Compliance Officer
(973) 517-4076

Signed By Date

10/13/2021

340B Drug Pricing Program Database