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LOISAIDA RX INC
CH020490 William F. Ryan Community Health Center, Inc.
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Covered Entity Details
Entity Name
William F. Ryan Community Health Center, Inc.
Subdivision Name
Ryan Health | West 97th Street
Type
HRSA-Funded Health Center
340B ID
CH020490
Entity Address
110 W 97th St
NEW YORK, NY 10025-6450
Grant Number
H80CS00061
Participating Start Date
7/1/1998
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
LOISAIDA RX INC
Pharmacy Address
D/B/A LOISAIDA DRUGS & SURGICAL
273 E 3RD ST
NEW YORK, NY 10009
Pharmacy Comments
Contract Details
Approval Date
4/1/2004
Contract Begin Date
4/1/2004
Carve-In Effective Date
Contract Comments
6/15/06 - ADDRESS CHANGE (WAS 36 AVENUE C)
Contacts
Covered Entity Signing Official
Barbra E. Minch, CEO
(212) 316-7917
Contract Pharmacy Representative
JAGADEESH GUMMELLA, PRESIDENT
(212) 254-7307
Signed By Date
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