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CIVA DRUGS CORP
CH02151BH Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
LISH at Smithtown
Type
HRSA-Funded Health Center
340B ID
CH02151BH
Entity Address
75 Landing Meadow Road
Smithtown, NY 11787
Grant Number
H80CS00313
Participating Start Date
1/1/2017
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
CIVA DRUGS CORP
Pharmacy Address
DBA BRENTWOOD PHARMACY
761 SUFFOLK AVE
BRENTWOOD, NY 11717
Pharmacy Comments
Contract Details
Approval Date
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
Civa Drugs Corp
Digesh Thaker, Pharmacist/Owner
(631) 273-3314
Signed By Date
7/11/2017
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