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PAAK PHARMACY, INC
CH02151BM Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
LISH at Riverhead
Type
HRSA-Funded Health Center
340B ID
CH02151BM
Entity Address
883 East Main Street
Riverhead, NY 11901
Grant Number
H80CS00313
Participating Start Date
1/1/2017
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
PAAK PHARMACY, INC
Pharmacy Address
112 PHARMACY & SURGICAL
689 MEDFORD AVE
PATCHOGUE, NY 11772
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
Prasad Venigalla, President
(914) 734-8719
Signed By Date
7/18/2017
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