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HISPANIOLA PHARMACEUTICAL GROUP INC
FQHCLA334 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
Washington Heights
Type
Health Center Program Look-Alike
340B ID
FQHCLA334
Entity Address
600 W 168th St
New York, NY 10032-3702
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
1/31/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
HISPANIOLA PHARMACEUTICAL GROUP INC
Pharmacy Address
D/B/A SOUTH BRONX PHARMACY
411 EAST 138TH STREET
BRONX, NY 10454
Pharmacy Comments
Contract Details
Approval Date
7/28/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/21/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Hispaniola Pharmaceutical Group
Reddy Bomreddy, Owner
(718) 401-7900 Ext: 7186209000
Signed By Date
7/28/2016
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