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RAPPS PHARMACY
RWI07060 Hyacinth Foundation
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Covered Entity Details
Entity Name
Hyacinth Foundation
Subdivision Name
Plainfield
Type
Ryan White Part A
340B ID
RWI07060
Entity Address
107 Park Avenue, 3rd Floor
Plainfield, NJ 07060
Grant Number
H89HA00026
Participating Start Date
1/1/2014
Last Recertification Date
2/13/2017
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
RAPPS PHARMACY
Pharmacy Address
611 PARK AVE
PLAINFIELD, NJ 07060
Pharmacy Comments
Contract Details
Approval Date
1/10/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
Kathy Ahearn-O'Brien, Executive Director
(732) 246-0204
Contract Pharmacy Representative
Fungisai Nota, 340B Program Manager
(610) 675-6594
Signed By Date
1/10/2014
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