Contract Pharmacy Details

LOISAIDA RX INC
FQHCLA334 NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

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

LOISAIDA RX INC

Pharmacy Address

D/B/A LOISAIDA DRUGS & SURGICAL
273 E 3RD ST
NEW YORK, NY 10009

Pharmacy Comments

Contract Details

Approval Date

10/13/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

Loisaida Rx Inc
Jay Gummella, Point of Contact
(212) 254-7307

Signed By Date

10/13/2016

340B Drug Pricing Program Database