Contract Pharmacy Details

RJ PHARMACY, 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

RJ PHARMACY, INC.

Pharmacy Address

2111 WILLIAMSBRIDGE RD
BRONX, NY 10461-1601

Pharmacy Comments

Contract Details

Approval Date

1/19/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/20/2017
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

RJ Pharmacy
Roland Merseni, RPH
(347) 691-3701

Signed By Date

1/19/2017

340B Drug Pricing Program Database