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27 AUDUBON PHARMACY CORP.
RWI10029 AIDS Service Center of Lower Manhattan Inc
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Covered Entity Details
Entity Name
AIDS Service Center of Lower Manhattan Inc
Subdivision Name
Type
Ryan White Part A
340B ID
RWI10029
Entity Address
315 East 104th St.
New York, NY 10029
Grant Number
H89HA00015
Participating Start Date
6/11/2013
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
27 AUDUBON PHARMACY CORP.
Pharmacy Address
D/B/A QUICK RX
27 AUDUBON AVENUE
NEW YORK, NY 10032
Pharmacy Comments
Contract Details
Approval Date
7/7/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Philip Zweiger, CFO
(212) 645-0875 Ext: 314
Contract Pharmacy Representative
Richard Balcharan, Pharmacist
(646) 448-4848
Signed By Date
7/7/2014
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