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BILLSTRA PHARMACY
RWI075051 Coalition on AIDS in Passaic County, Inc.
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Covered Entity Details
Entity Name
Coalition on AIDS in Passaic County, Inc.
Subdivision Name
CAPCO/Paterson
Type
Ryan White Part A
340B ID
RWI075051
Entity Address
100 Hamilton Plaza, Suite 1406
Paterson, NJ 07505
Grant Number
H89HA00026
Participating Start Date
7/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
BILLSTRA PHARMACY
Pharmacy Address
608 21ST AVE
PATERSON, NJ 07513
Pharmacy Comments
Contract Details
Approval Date
10/4/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jerry C. Dillard, Executive Director/CEO
(973) 742-6742 Ext: 305
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
10/4/2017
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