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KINGS PARK SLOPE INC
CHC26631-00 LA CASA DE SALUD INC.
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Covered Entity Details
Entity Name
LA CASA DE SALUD INC.
Subdivision Name
La Casa de Salud, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC26631-00
Entity Address
966 Prospect Ave
Bronx, NY 10459-3270
Grant Number
H80CS26631
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
KINGS PARK SLOPE INC
Pharmacy Address
D/B/A KINGS SUPER PHARMACY
357 FLATBUSH AVE
BROOKLYN, NY 11238
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/19/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela Mattel, CEO
(718) 960-7601
Contract Pharmacy Representative
Kings Park Slope
Ron Delgaudio, President/CEO
(718) 230-3535
Signed By Date
10/16/2017
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