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872 HPA DRUG CORP
CHC26631-00 LA CASA DE SALUD INC.
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Covered Entity Details
Entity Name
LA CASA DE SALUD INC.
Subdivision Name
La Casa de Salud, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC26631-00
Entity Address
966 Prospect Ave
Bronx, NY 10459-3270
Grant Number
H80CS26631
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
872 HPA DRUG CORP
Pharmacy Address
BOCA PHARMACY
736 EAST 152ND STREET
BRONX, NY 10455
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pamela Mattel, CEO
(718) 960-7601
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
4/15/2015
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