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866 EAST TREMONT PHARMACY LLC
STD35404 West Alabama Women's Center Inc.
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Covered Entity Details
Entity Name
West Alabama Women's Center Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD35404
Entity Address
535 Jack Warner Pkwy NE
Suite I
Tuscaloosa, AL 35404
Grant Number
NH25PS005129-03-00
Participating Start Date
10/1/2023
Last Recertification Date
5/6/2024
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
8/18/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Marty, Director of Operations
(205) 556-2026
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
7/6/2023
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