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TOMPKINSVILLE PHARMACY INC
CHC16639-00 COMMUNITY HEALTH CENTER OF RICHMOND, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF RICHMOND, INC.
Subdivision Name
CHCR
Type
HRSA-Funded Health Center
340B ID
CHC16639-00
Entity Address
235 Port Richmond Avenue
Staten Island, NY 10302-1701
Grant Number
H80CS16639
Participating Start Date
7/1/2008
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
TOMPKINSVILLE PHARMACY INC
Pharmacy Address
GANGADIN, ESAR
45 VICTORY BLVD.
STATEN ISLAND, NY 10301
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Ownership change
Contacts
Covered Entity Signing Official
HENRY THOMPSON, EXECUTIVE DIRECTOR
(718) 876-2599
Contract Pharmacy Representative
Tompkinsville Pharmacy
Esar Gangadin, Owner
(718) 727-0430
Signed By Date
7/14/2017
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