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LINDENWOOD RX CENTER INC
CH021917A UPPER ROOM AIDS MINISTRY, INC.: ADULT DAY HEALTH CARE CENTER
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Covered Entity Details
Entity Name
UPPER ROOM AIDS MINISTRY, INC.: ADULT DAY HEALTH CARE CENTER
Subdivision Name
Willis P Green Health Center
Type
HRSA-Funded Health Center
340B ID
CH021917A
Entity Address
123-125 West 124th St
New York, NY 10027-4920
Grant Number
H80CS17251
Participating Start Date
7/1/2008
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
LINDENWOOD RX CENTER INC
Pharmacy Address
LIRX
1380 LORING AVE
C/O PHARMACY
BROOKLYN, NY 11208
Pharmacy Comments
Contract Details
Approval Date
1/7/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jacquelyn Kilmer, CEO
(212) 803-2886
Contract Pharmacy Representative
LIRX
Jitendra Patel, Director Of Pharmacy
(718) 277-0898
Signed By Date
1/7/2016
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