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866 EAST TREMONT PHARMACY LLC
RWI55114 SAYFSM
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Covered Entity Details
Entity Name
SAYFSM
Subdivision Name
Type
Ryan White Part A
340B ID
RWI55114
Entity Address
2395 University Ave. #200
St. Paul, MN 55114
Grant Number
H89HA00050
Participating Start Date
7/1/2022
Last Recertification Date
3/3/2025
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
6/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ephraim Olani, Ex. Director
(651) 644-3983 Ext: 6516443983
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
4/5/2022
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