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31ST & 3RD PHARMACY INC
RWI10032 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
RWI10032
Entity Address
2036 Amsterdam Avenue
New York, NY 10032
Grant Number
H89HA00015
Participating Start Date
6/11/2013
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
31ST & 3RD PHARMACY INC
Pharmacy Address
D/B/A AVITA PHARMACY 1063
1860 WALT WHITMAN RD STE 700
MELVILLE, NY 11747
Pharmacy Comments
Contract Details
Approval Date
4/29/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Philip Zweiger, CFO
(212) 645-0875 Ext: 314
Contract Pharmacy Representative
Paramount / Island Care Specialty Pharmacy
Al DosSantos, Founding Principal
(516) 322-3216
Signed By Date
4/29/2014
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