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866 EAST TREMONT PHARMACY LLC
STD33169 ALIVE and WELL COMMUNITY PARTNERS
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Covered Entity Details
Entity Name
ALIVE and WELL COMMUNITY PARTNERS
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33169
Entity Address
18425 N.W. 2ND AVENUE
5TH FLOOR
PH-7
MIAMI, FL 33169
Grant Number
NH25PS005131
Participating Start Date
1/1/2020
Last Recertification Date
5/25/2024
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
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FRANKIE TAYLOR, DIRECTOR OF OPERATIONS
(800) 434-1366 Ext: 1002
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
7/17/2023
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