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5407 PHARMACY INC
CH021887D SUNSET PARK HEALTH COUNCIL, INC.
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Covered Entity Details
Entity Name
SUNSET PARK HEALTH COUNCIL, INC.
Subdivision Name
PARK RIDGE FAMILY HEALTH CENTER at NYU LANGONE
Type
HRSA-Funded Health Center
340B ID
CH021887D
Entity Address
6317 - 4TH AVE
BROOKLYN, NY 11220
Grant Number
H80CS07914
Participating Start Date
1/1/2004
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
5407 PHARMACY INC
Pharmacy Address
LUTHERAN PHARMACY
5407 2ND AVE
BROOKLYN, NY 11220
Pharmacy Comments
Contract Details
Approval Date
8/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/4/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Larry K. McReynolds, Executive Director
(718) 630-7216
Contract Pharmacy Representative
5407 Pharmacy, Inc.
Dil Choudhary, Owner & President
(718) 492-8900
Signed By Date
8/10/2017
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