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866 EAST TREMONT PHARMACY LLC
STD39110 Institute for the Advancement of Minority health
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Covered Entity Details
Entity Name
Institute for the Advancement of Minority health
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD39110
Entity Address
682 Towne Center Blvd
Suite 103
Ridgeland, MS 39157-5158
Grant Number
6NU62PS924746-02-01
Participating Start Date
4/1/2023
Last Recertification Date
5/9/2025
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
1/4/2023
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sandra Melvin, Chief Executive Officer
(769) 225-2193
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
12/30/2022
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