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MEDLY QUEENS INC.
CH02848C DAMIAN FAMILY CARE CENTERS, INC.
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Covered Entity Details
Entity Name
DAMIAN FAMILY CARE CENTERS, INC.
Subdivision Name
Fire House Health Center
Type
HRSA-Funded Health Center
340B ID
CH02848C
Entity Address
8956 162nd St
Jamaica, NY 11432-5072
Grant Number
H80CS01765
Participating Start Date
4/12/2013
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEDLY QUEENS INC.
Pharmacy Address
DBA: MEDLY PHARMACY
89-56 162ND ST
JAMAICA, NY 11432
Pharmacy Comments
Contract Details
Approval Date
2/3/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Peter Grisafi, CEO
(718) 657-1100 Ext: 1225
Contract Pharmacy Representative
Medley Pharmacy
Nate Coney, VP
(609) 992-9692
Signed By Date
2/3/2022
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