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SOUTHERN PHARMACY INC.
CH02360AA URBAN HEALTH PLAN, INC.
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Covered Entity Details
Entity Name
URBAN HEALTH PLAN, INC.
Subdivision Name
VIDA Guidance Center
Type
HRSA-Funded Health Center
340B ID
CH02360AA
Entity Address
4419 Third Avenue
Bronx, NY 10457-2562
Grant Number
H80CS00368
Participating Start Date
7/1/2019
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
SOUTHERN PHARMACY INC.
Pharmacy Address
1301 SOUTHERN BLVD
BRONX, NY 10459-1504
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paloma Hernandez, President and CEO
(718) 589-2440 Ext: 4219
Contract Pharmacy Representative
Sobro Pharmacy, Inc.
Benjamin Davidov, President
(917) 364-3233
Signed By Date
10/13/2022
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