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PENNSYLVANIA CVS PHARMACY, L.L.C.
CH020490 William F. Ryan Community Health Center, Inc.
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Covered Entity Details
Entity Name
William F. Ryan Community Health Center, Inc.
Subdivision Name
Ryan Health | West 97th Street
Type
HRSA-Funded Health Center
340B ID
CH020490
Entity Address
110 W 97th St
NEW YORK, NY 10025-6450
Grant Number
H80CS00061
Participating Start Date
7/1/1998
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #342
3016 ROUTE 940
P. O. BOX 2320
POCONO SUMMIT, PA 18346
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose J. Virella, Chief Financial Officer
(917) 842-3011
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2024
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