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DUANE READE
FQHCLA334A NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
Sydenham Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA334A
Entity Address
264 W 118th St
New York, NY 10026-1736
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
2/10/2019
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
DUANE READE
Pharmacy Address
279 W 125TH STREET
NEW YORK, NY 10027-4408
Pharmacy Comments
11/05/2012 DEA check, name upadte(was Walgreens #14148)
Contract Details
Approval Date
7/12/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/20/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2016
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