Contract Pharmacy Details

5407 PHARMACY INC
CH021887E SUNSET PARK HEALTH COUNCIL, INC.

Covered Entity Details

Entity Name

SUNSET PARK HEALTH COUNCIL, INC.

Subdivision Name

SHORE ROAD FAMILY HEALTH CENTER at NYU LANGONE

Type

HRSA-Funded Health Center

340B ID

CH021887E

Entity Address

9000 SHORE ROAD
BROOKLYN, NY 11209

Grant Number

H80CS07914

Participating Start Date

1/1/2004

Last Recertification Date

3/2/2018

Entity Termination Date

4/1/2019

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

4/1/2019
Covered Entity Terminated

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

340B Drug Pricing Program Database