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MEDFORD CHEMISTS INC
CH02151BK Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
LISH at Manorville
Type
HRSA-Funded Health Center
340B ID
CH02151BK
Entity Address
221 North Sunrise Service Road
Manorville, NY 11949
Grant Number
H80CS00313
Participating Start Date
1/1/2017
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MEDFORD CHEMISTS INC
Pharmacy Address
2608 ROUTE 112
MEDFORD, NY 11763
Pharmacy Comments
Contract Details
Approval Date
4/6/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
Crystal Koller, Vice President, Finance & Operations
(631) 475-1171
Signed By Date
4/6/2017
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