Contract Pharmacy Details

870 SOUTHERN DRUG CORP
RWI10532 Hudson Valley Community Services, Inc.

Covered Entity Details

Entity Name

Hudson Valley Community Services, Inc.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI10532

Entity Address

40 Saw Mill River Road
Hawthorne, NY 10532

Grant Number

H89HA00020

Participating Start Date

1/1/2014

Last Recertification Date

2/6/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

870 SOUTHERN DRUG CORP

Pharmacy Address

D/B/A AVITA PHARMACY 1064
924 MYRTLE AVE
BROOKLYN, NY 11206

Pharmacy Comments

Contract Details

Approval Date

10/14/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jeffrey Kraus, Executive Director
(914) 785-8210

Contract Pharmacy Representative

PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033

Signed By Date

10/14/2014

340B Drug Pricing Program Database