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CUSTOM RX, INC
CH02848C DAMIAN FAMILY CARE CENTERS, INC.
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Covered Entity Details
Entity Name
DAMIAN FAMILY CARE CENTERS, INC.
Subdivision Name
Fire House Health Center
Type
HRSA-Funded Health Center
340B ID
CH02848C
Entity Address
8956 162nd St
Jamaica, NY 11432-5072
Grant Number
H80CS01765
Participating Start Date
4/12/2013
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
5/1/2023
Business decision by covered entity and/or pharmacy
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
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