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866 EAST TREMONT PHARMACY LLC
STD83714 El-Ada, Inc.
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Covered Entity Details
Entity Name
El-Ada, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD83714
Entity Address
701 E 44th st
1
Garden City, ID 83714
Grant Number
NH25PS005171
Participating Start Date
10/1/2023
Last Recertification Date
5/13/2025
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
8/25/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katrina Marie Vincent, CEO
(208) 761-3652
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
7/11/2023
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