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MEDFORD CHEMISTS INC
CH02151DC SUN RIVER HEALTH, INC.
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Covered Entity Details
Entity Name
SUN RIVER HEALTH, INC.
Subdivision Name
Charles Evans Center Seaford
Type
HRSA-Funded Health Center
340B ID
CH02151DC
Entity Address
2146 Jackson Ave
Seaford, NY 11783-2606
Grant Number
H80CS00313
Participating Start Date
7/1/2024
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MEDFORD CHEMISTS INC
Pharmacy Address
2608 ROUTE 112
MEDFORD, NY 11763
Pharmacy Comments
Contract Details
Approval Date
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/8/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allison Dubois, COO
(914) 734-8600 Ext: 78503
Contract Pharmacy Representative
Medford Chemists Inc
Crystal Koller, Vice President, Finance & Operations
(631) 475-1171
Signed By Date
4/1/2025
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