Contract Pharmacy Details

CUSTOM RX, INC
CH028480 DAMIAN FAMILY CARE CENTERS, INC.

Covered Entity Details

Entity Name

DAMIAN FAMILY CARE CENTERS, INC.

Subdivision Name

DBA PROJECT SAMARITAN HEALTH SERVICES

Type

HRSA-Funded Health Center

340B ID

CH028480

Entity Address

13750 Jamaica Ave
Jamaica, NY 11435-3610

Grant Number

H80CS01765

Participating Start Date

9/4/2008

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

CUSTOM RX, INC

Pharmacy Address

90-09 37TH AVE
JACKSON HEIGHTS, NY 11372

Pharmacy Comments

Contract Details

Approval Date

1/9/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/13/2025
Ownership change

Contacts

Covered Entity Signing Official

Peter Grisafi, CEO
(718) 657-1100 Ext: 1225

Contract Pharmacy Representative

CustomRx
Janet Escalante, CEO
(718) 775-5018

Signed By Date

1/9/2023