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PHYSICIANS RX PHARMACY OF CLINTON, INC.
CH040310 BORINQUEN HEALTH CARE CENTER INC
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Covered Entity Details
Entity Name
BORINQUEN HEALTH CARE CENTER INC
Subdivision Name
BMC Emilio Lopez Pavilion (Main Site)
Type
HRSA-Funded Health Center
340B ID
CH040310
Entity Address
3601 Federal Hwy
Miami, FL 33137-3795
Grant Number
H80CS00618
Participating Start Date
4/1/1996
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
PHYSICIANS RX PHARMACY OF CLINTON, INC.
Pharmacy Address
PHYSICIANS RX PHARMACY CLINTON
9131 PISCATAWAY ROAD
SUITE 670
CLINTON, MD 20735
Pharmacy Comments
Contract Details
Approval Date
1/11/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Deborah Gracia, CMO
(305) 576-6611 Ext: 1609
Contract Pharmacy Representative
Physicians Rx Pharmacy of Clinton
Chris Wakefield, Manager
(412) 357-5163
Signed By Date
1/11/2017
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