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904 PROSPECT PHARMACY INC
CH02360D URBAN HEALTH PLAN, INC.
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Covered Entity Details
Entity Name
URBAN HEALTH PLAN, INC.
Subdivision Name
Peninsula Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH02360D
Entity Address
1967 Turnbull Avenue FL 2
Bronx, NY 10473
Grant Number
H80CS00368
Participating Start Date
10/1/2012
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
904 PROSPECT PHARMACY INC
Pharmacy Address
D/B/A BOCA PHARMACY
904 PROSPECT AVE
BRONX, NY 10459-3929
Pharmacy Comments
Contract Details
Approval Date
12/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paloma Hernandez, President and CEO
(718) 589-2440 Ext: 4219
Contract Pharmacy Representative
Boca Pharmacy
Jacob Jamron, CEO
(718) 991-6700
Signed By Date
12/13/2017
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