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CROWN PHARMA INC
CH021887U SUNSET PARK HEALTH COUNCIL, INC.
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Covered Entity Details
Entity Name
SUNSET PARK HEALTH COUNCIL, INC.
Subdivision Name
Metro Community Health Centers - Staten island
Type
HRSA-Funded Health Center
340B ID
CH021887U
Entity Address
2324 Forest Avenue
Staten Island, NY 10303
Grant Number
H80CS07914
Participating Start Date
4/1/2016
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
CROWN PHARMA INC
Pharmacy Address
DBA-LAVIDA PHARMACY
40-20 82ND ST
ELMHURST, NY 11373-1305
Pharmacy Comments
Contract Details
Approval Date
10/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry K. McReynolds, Executive Director
(718) 630-7216
Contract Pharmacy Representative
Crown Pharmacy
Ratna Chakilam, Main Contact
(718) 426-2525
Signed By Date
10/6/2023
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