Contract Pharmacy Details

866 EAST TREMONT PHARMACY LLC
FP392157 Converge

Covered Entity Details

Entity Name

Converge

Subdivision Name

Clinical Operations

Type

Family Planning (Title X only)

340B ID

FP392157

Entity Address

715 S Pear Orchard Rd
402
Ridgeland, MS 39157

Grant Number

FPHPA006550

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

10/11/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kathryn Danielle Lampton, Co-Director
(601) 497-2618

Contract Pharmacy Representative

Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700

Signed By Date

10/11/2023