Contract Pharmacy Details

MEDLY PHARMACY
STD076012 Buddies of NJ, Inc.

Covered Entity Details

Entity Name

Buddies of NJ, Inc.

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD076012

Entity Address

149 HUDSON ST
Hackensack, NJ 07601-6861

Grant Number

NH25PS005174-01-00

Participating Start Date

10/1/2021

Last Recertification Date

5/8/2024

Pharmacy Details

Pharmacy Name

MEDLY PHARMACY

Pharmacy Address

40 W MAIN ST
SOMERVILLE, NJ 08876

Pharmacy Comments

Contract Details

Approval Date

10/15/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/10/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Richard Miles, Executive Director
(201) 344-4412 Ext: 112

Contract Pharmacy Representative

Medly
Nate Coney, VP 340B Program
(908) 725-0585

Signed By Date

10/15/2021