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866 EAST TREMONT PHARMACY LLC
RWI01608 AIDS Project Worcester Inc.
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Covered Entity Details
Entity Name
AIDS Project Worcester Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI01608
Entity Address
165 Southbridge Street
WORCESTER, MA 01608
Grant Number
H89HA00011
Participating Start Date
4/1/2023
Last Recertification Date
2/9/2024
Entity Termination Date
4/1/2025
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
1/24/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michelle Smith, CEO
(508) 755-3773
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
1/11/2023
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