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DEDRICK'S PHARMACY INC
CH02371Z INSTITUTE FOR FAMILY HEALTH, THE
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Covered Entity Details
Entity Name
INSTITUTE FOR FAMILY HEALTH, THE
Subdivision Name
FAMILY HEALTH CENTER OF PORT EWEN
Type
HRSA-Funded Health Center
340B ID
CH02371Z
Entity Address
213 BROADWAY
PORT EWEN, NY 12401-5901
Grant Number
H80CS00768
Participating Start Date
10/1/2007
Last Recertification Date
2/2/2022
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
DEDRICK'S PHARMACY INC
Pharmacy Address
86 N FRONT ST
KINGSTON, NY 12401-3832
Pharmacy Comments
Contract Details
Approval Date
11/25/2011
Contract Begin Date
11/25/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/4/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peter Grisafi, Senior Vice President & COO
(212) 633-0800 Ext: 1225
Contract Pharmacy Representative
George S. Nekos, Supervising Pharmacist
(845) 338-8000
Signed By Date
11/9/2011
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