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IC PHARMACY LLC
CHC28988-00 DAP HEALTH INC
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Covered Entity Details
Entity Name
DAP HEALTH INC
Subdivision Name
Desert AIDS Project, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC28988-00
Entity Address
1695 N Sunrise Way
Palm Springs, CA 92262-3701
Grant Number
H80CS28988
Participating Start Date
4/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
IC PHARMACY LLC
Pharmacy Address
AMAZON PHARMACY #004
34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYN, NY 11232
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/10/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Judy Stith, Chief Administration Officer
(760) 323-2118 Ext: 526
Contract Pharmacy Representative
AMAZON PHARMACY
JOHN M LAVIN, MANAGING OFFICER
(602) 793-8552
Signed By Date
7/12/2024
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