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2818 FULTON PHARMACY INC.
CHC22680-00 HEALTHCARE CHOICES NY, INC.
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Covered Entity Details
Entity Name
HEALTHCARE CHOICES NY, INC.
Subdivision Name
HealthCare Choices NY, Inc. - Brooklyn
Type
HRSA-Funded Health Center
340B ID
CHC22680-00
Entity Address
6209 16th Ave
Brooklyn, NY 11204-2702
Grant Number
H80CS22680
Participating Start Date
7/1/2012
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
2818 FULTON PHARMACY INC.
Pharmacy Address
D/B/A FULTON PHARMACY
2818 FULTON ST
BROOKLYN, NY 11207
Pharmacy Comments
Contract Details
Approval Date
12/16/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maria Siebel, CEO
(718) 234-0073 Ext: 26003
Contract Pharmacy Representative
Fulton Pharmacy
Rafail Matatov, Pharmacist
(718) 235-6394
Signed By Date
12/16/2024
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