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31ST & 3RD PHARMACY INC
HV022690 NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
SYDENHAM HEALTH CARE NETWORK
Type
Ryan White Part C
340B ID
HV022690
Entity Address
264 W 118th St
NEW YORK, NY 10026
Grant Number
H76HA00034
Participating Start Date
12/1/1992
Last Recertification Date
2/8/2018
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
31ST & 3RD PHARMACY INC
Pharmacy Address
D/B/A AVITA PHARMACY 1063
1860 WALT WHITMAN RD STE 700
MELVILLE, NY 11747
Pharmacy Comments
Contract Details
Approval Date
1/16/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/19/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Paramount SPecialty
Al DosSantos, Founding Principle
(631) 815-5776
Signed By Date
1/16/2018
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