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866 EAST TREMONT PHARMACY LLC
STD19153 Courage Medicine Health Center, Inc
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Covered Entity Details
Entity Name
Courage Medicine Health Center, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD19153
Entity Address
3751 Island Ave
201
Philadelphia, PA 19153
Grant Number
NH25PS005233-01-00
Participating Start Date
1/1/2024
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
11/27/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Carson Moore, Executive Director
(215) 510-5199
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
11/20/2023
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