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866 EAST TREMONT PHARMACY LLC
STD19143 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
STD19143
Entity Address
3045 Kensington Avenue
Philadelphia, PA 19134
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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