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TOMPKINSVILLE PHARMACY INC
CHC16639-02 COMMUNITY HEALTH CENTER OF RICHMOND, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF RICHMOND, INC.
Subdivision Name
CHCR - 135 Canal St, 3rd Floor
Type
HRSA-Funded Health Center
340B ID
CHC16639-02
Entity Address
135 CANAL ST
STATEN ISLAND, NY 10304-2059
Grant Number
H80CS16639
Participating Start Date
7/1/2016
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
TOMPKINSVILLE PHARMACY INC
Pharmacy Address
GANGADIN, ESAR
45 VICTORY BLVD.
STATEN ISLAND, NY 10301
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Ownership change
Contacts
Covered Entity Signing Official
Benito Lindo, CFO
(718) 924-2254 Ext: 7414
Contract Pharmacy Representative
Tompkinsville Pharmacy
Esar Gangadin, Owner
(718) 727-0430
Signed By Date
7/14/2017
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