Contract Pharmacy Details

ACARIAHEALTH PHARMACY #12, INC.
CH024690 COMMUNITY HEALTH CENTER OF BUFFALO, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTER OF BUFFALO, INC.

Subdivision Name

34 Benwood Ave Buffalo, NY 14214

Type

HRSA-Funded Health Center

340B ID

CH024690

Entity Address

34 Benwood
Buffalo, NY 14214-1761

Grant Number

H80CS00157

Participating Start Date

4/1/2003

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

ACARIAHEALTH PHARMACY #12, INC.

Pharmacy Address

5 SKYLINE DR STE 240
HAWTHORNE, NY 10532-2166

Pharmacy Comments

Contract Details

Approval Date

10/7/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

LaVonne Ansari, CEO
(716) 986-9199 Ext: 1002

Contract Pharmacy Representative

Acaria Health
Philip Gofman, Regional VP
(917) 312-5263

Signed By Date

10/7/2022

340B Drug Pricing Program Database