Covered Entity Details

DSH330014 JAMAICA HOSPITAL MEDICAL CENTER (Active) - information as of 5/26/2025 12:51:22 AM

Main Details

Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330014

Medicare Provider Number

330014

Additional Details

Current Program Status

Active

Registration Date

10/19/2006

Participating Start Date

10/1/2004

Participating Approval Date

10/19/2006

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Jamaica Hospital
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Primary Contact

Jamaica Hospital Medical Center
Louis Cosenza, Director
(718) 206-6052

Addresses

Street Address

8900 VAN WYCK EXPRESSWAY
JAMAICA, NY 11418

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NY	00243852	1245370717

Shipping Addresses

Shipping Address 1

JAMAICA HOSPITAL MEDICAL CENTER
89th Ave & Van Wyck Exp.
JAMAICA, NY 11418

Shipping Address 2

JAMAICA HOSPITAL MEDICAL CENTER
8900 VAN WYCK EXPRESSWAY
JAMAICA, NY 11418

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/12/2023	10/01/2023	12/12/2024	01/29/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	11411 STRANG LINE RD	STE A	LENEXA	KS	66215	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	AL SAFA AL MARWAH, INC.	D/B/A NORWOOD CARE PHARMACY	3138 FULTON ST	BROOKLYN	NY	11208	01/12/2022	04/01/2022	09/14/2023	09/18/2023
Contract Detail	AN-NOOR PHARMACY INC	35 101ST AVE		BROOKLYN	NY	11208	01/11/2019	04/01/2019	01/11/2023	01/17/2023
Contract Detail	AS-SALAM PHARMACY INC.	AS-SALAM PHARMACY INC	147-26 HILLSIDE AVE	JAMAICA	NY	11435	10/07/2021	01/01/2022	10/11/2022	10/12/2022
Contract Detail	BISMILLAH 1 CORPORATION	DBA ELTON PHARMACY	2992 FULTON ST	BROOKLYN	NY	11208	01/18/2022	04/01/2022		06/14/2023
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/08/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/08/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/08/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/08/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/08/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/13/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01153	1875 BOSTON AVE, CVS PLAZA	BRIDGEPORT	CT	06610	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01912	1968 BLACK ROCK TURNPIKE. FAIRWAY PLAZA	FAIRFIELD	CT	06825	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CROSSBAY CHEMISTS CORP	D/B/A CROSS BAY CHEMIST	157-02 CROSSBAY BLVD	HOWARD BEACH	NY	11414-2753	07/14/2016	10/01/2016	06/01/2021	06/03/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02041	83-02 ATLANTIC AVENUE	OZONE PARK	NY	11416	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02062	85-29 126TH STREET	KEW GARDENS	NY	11415	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02719	97-01 LIBERTY AVE.	OZONE PARK	NY	11417	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03621	170-05 LINDEN BLVD.	JAMAICA	NY	11434	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 06030	157-05 CROSS BAY BLVD.	HOWARD BEACH	NY	11414	07/11/2018	10/01/2018		10/01/2018
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00144	219-39 89TH AVENUE	QUEENS VILLAGE	NY	11427	10/11/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00499	118-10 QUEENS BOULEVARD	FOREST HILLS	NY	11375	10/11/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02718	178-02 HILLSIDE AVE.	JAMAICA	NY	11432	10/11/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03138	206-09 LINDEN BOULEVARD	CAMBRIA HEIGHTS	NY	11411	10/11/2018	01/01/2019		01/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02975	7960 METROPOLITAN AVENUE	MIDDLE VILLAGE	NY	11379	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00549	61-15 METROPOLITAN AVE	RIDGEWOOD	NY	11385	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00601	272 8TH AVENUE	NEW YORK	NY	10011	04/10/2019	07/01/2019	07/31/2021	09/30/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01107	68-02 MYRTLE AVENUE	GLENDALE	NY	11385	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01113	89-11 NORTHERN BLVD.	JACKSON HEIGHTS	NY	11372	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01954	132-22 14TH AVENUE	COLLEGE POINT	NY	11356	04/10/2019	07/01/2019	04/05/2023	04/12/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02057	100-02 QUEENS BOULEVARD	FOREST HILLS	NY	11375	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02095	61-26 188TH STREET	FRESH MEADOWS	NY	11365	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 2280	329-339 WYCKOFF AVE	RIDGEWOOD	NY	11385	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02433	2112 WHITE PLAINS ROAD	BRONX	NY	10462	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02436	1346 PENNSYLVANIA AVENUE	BROOKLYN	NY	11239	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02442	271 BEACH 20TH STREET	FAR ROCKAWAY	NY	11691	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02769	4901 KINGS HIGHWAY	BROOKLYN	NY	11234	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02906	10204 FLATLANDS AVE.	BROOKLYN	NY	11236	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 3146	30-97 STEINWAY ST.	ASTORIA	NY	11103	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 07067	1916 WILLIAMSBRIDGE ROAD	BRONX	NY	10461	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY #07576	3101 DITMARS BLVD.	ASTORIA	NY	11105	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 07881	97-15 METROPOLITAN AVENUE	FOREST HILLS	NY	11375	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00491	7209 NORTHERN BLVD	JACKSON HEIGHTS	NY	11372	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02498	341 9TH STREET	BROOKLYN	NY	11215	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02574	6702 FT. HAMILTON PARKWAY	BROOKLYN	NY	11219	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 06046	2690 HYLAN BLVD	STATEN ISLAND	NY	10306	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 10086	30 FLATBUSH AVE.	BROOKLYN	NY	11217	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 10298	241 WEST 57TH STREET	NEW YORK	NY	10019	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	CVS PHARMACY # 16740	519 GATEWAY DR	BROOKLYN	NY	11239	07/06/2020	10/01/2020		10/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01761	54-06 31ST AVENUE	WOODSIDE	NY	11377	04/12/2021	07/01/2021	05/20/2022	05/20/2022
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02028	216 HENRY STREET	HEMPSTEAD	NY	11550	04/12/2021	07/01/2021		07/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02344	1249 NOSTRAND AVENUE	BROOKLYN	NY	11225	04/12/2021	07/01/2021		07/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02360	743 AMSTERDAM AVENUE	NEW YORK	NY	10025	04/12/2021	07/01/2021		07/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02720	88-07 ROCKAWAY BEACH BLVD.	ROCKAWAY BEACH	NY	11693	04/12/2021	07/01/2021		07/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02211	701 WELLWOOD AVENUE	LINDENHURST	NY	11757	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 7186	420 FIFTH AVE	NEW YORK	NY	10018	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 04611	951 ATLANTIC AVE	BALDWIN	NY	11510	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02440	530 BURNSIDE AVENUE	INWOOD	NY	11096	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02721	935 HORSEBLOCK RD.	FARMINGVILLE	NY	11738	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00992	403 ATLANTIC AVENUE	FREEPORT	NY	11520	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01073	450 MAIN STREET	FARMINGDALE	NY	11735	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02961	2 E. JERICHO TPKE	HUNTINGTON STATION	NY	11746	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05773	69-80 GRAND AVE.	MASPETH	NY	11378	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02365	640 FRANKLIN AVENUE	FRANKLIN SQUARE	NY	11010	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02400	1223 2ND AVENUE	NEW YORK	NY	10065	07/12/2021	10/01/2021	10/10/2023	11/20/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03102	60 MILL HILL RD.	WOODSTOCK	NY	12498	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01169	44 NORTH CENTRAL AVENUE	VALLEY STREAM	NY	11580	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	CVS PHARMACY # 16683	8801 QUEENS BLVD	ELMHURST	NY	11373	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05368	1220 PENINSULA BLVD.	HEWLETT	NY	11557	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 13019	218 MYRTLE AVE.	BROOKLYN	NY	11201	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05367	116 WASHINGTON AVE., #128	CEDARHURST	NY	11516	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01951	1103 NORTH ST,	ENDICOTT	NY	13760	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 11038	153-01 10TH AVENUE	WHITESTONE	NY	11357	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/08/2019	01/01/2020		01/01/2020
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/08/2019	01/01/2020		01/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00055	1927 BEACON ST.	BRIGHTON	MA	02135	04/12/2021	07/01/2021		07/01/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/08/2020	04/01/2020		04/01/2020
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/12/2017	01/01/2018		10/12/2017
Contract Detail	DRUG RITE 3 PHARMACY CORP	DBA-HOYT PHARMACY & SURGICAL SUPPLIES	3038 ATLANTIC AVE	BROOKLYN	NY	11208	06/25/2020	07/01/2020		07/01/2020
Contract Detail	DUANE READE	84-32 JAMAICA AVENUE		WOODHAVEN	NY	11421	10/12/2017	01/01/2018		10/12/2017
Contract Detail	DUANE READE	103-09 LIBERTY AVENUE		OZONE PARK	NY	11417-1728	10/12/2017	01/01/2018	04/08/2019	04/08/2019
Contract Detail	DULARI CORP.	QUEENS DRUGS & SURGICAL	146-14 JAMAICA AVE ATTN: SUPERVISING PHARMACIST	JAMAICA	NY	11435-3628	10/12/2016	01/01/2017	09/14/2023	09/18/2023
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09131	10560-4S COMMONS DR.	SAN DIEGO	CA	92127	04/12/2021	07/01/2021		07/01/2021
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09581	32900 PACIFIC COAST HIGHWAY	DANA POINT	CA	92629	07/12/2021	10/01/2021		10/01/2021
Contract Detail	GENOA HEALTHCARE LLC	9114 37TH AVE STE E		JACKSON HEIGHTS	NY	11372	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	GENOA HEALTHCARE LLC	1448 5TH AVE STE P1		BAY SHORE	NY	11706	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	GENOA HEALTHCARE LLC	140 ROUTE 303 STE C		VALLEY COTTAGE	NY	10989	04/13/2023	07/01/2023	12/19/2024	12/19/2024
Contract Detail	GENOA HEALTHCARE LLC	1623 FLATBUSH AVE SITE 4		BROOKLYN	NY	11210	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	GENOA HEALTHCARE LLC	2020 CONEY ISLAND AVE STE P		BROOKLYN	NY	11223	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	GENOA HEALTHCARE LLC	380 NASSAU RD STE P		ROOSEVELT	NY	11575	07/12/2023	10/01/2023	12/12/2024	01/29/2025
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10608	96-02 ROCKAWAY BLVD.	OZONE PARK	NY	11417	01/11/2019	04/01/2019	10/14/2020	10/14/2020
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10607	102-30 ATLANTIC AVENUE	OZONE PARK	NY	11416	07/13/2022	10/01/2022	04/21/2025	04/24/2025
Contract Detail	JAMAICARX INC	JAMAICA HOSPITAL MEDICAL CENTER	89-36 VAN WYCK EXPRESSWAY	JAMAICA	NY	11418	02/09/2007	02/09/2007		10/28/2019
Contract Detail	JAMAICARX, INC.	CLOCK TOWER PHARMACY	91-20 ATLANTIC AVE	OZONE PARK	NY	11416	07/14/2016	10/01/2016		10/28/2019
Contract Detail	JAMAICARX, INC.	D/B/A MEDISYS RX PHARMACY	90-09 VAN WYCK EXPY	JAMAICA	NY	11435	07/05/2017	10/01/2017		10/28/2019
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05379	110 NC HWY 801 NORTH	ADVANCE	NC	27006	04/10/2019	07/01/2019		07/01/2019
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	01/15/2020	04/01/2020	10/07/2020	10/07/2020
Contract Detail	OPTUM INFUSION SERVICES 101, INC.	931 CONKLIN ST STE D		FARMINGDALE	NY	11735-2429	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	4000 CHEMICAL RD STE 100		PLYMOUTH MEETING	PA	19462	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	07/12/2023	10/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM INFUSION SERVICES 500, INC.	19 CHAPIN RD BLDG D	SUITE D7	PINE BROOK	NJ	07058-9385	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/13/2023	07/01/2023	12/12/2024	01/29/2025
Contract Detail	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/13/2023	07/01/2023	12/12/2024	01/29/2025
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/13/2023	07/01/2023	12/12/2024	12/16/2024
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01312	1111 NORTH 9TH ST.	STROUDSBURG	PA	18360	07/06/2020	10/01/2020		10/01/2020
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01641	1600 ALEXANDRA LANE	HARRISBURG	PA	17110	01/18/2022	04/01/2022		04/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10045	2239 PERKIOMEN AVE.	READING	PA	19606	01/18/2022	04/01/2022		04/01/2022
Contract Detail	PRIMARY CARE PHARMACY INC	90-20 SUTPHIN BLVD		JAMAICA	NY	11435	07/14/2016	10/01/2016	12/14/2023	12/19/2023
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/12/2017	01/01/2018	11/21/2022	11/22/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/11/2018	10/01/2018		10/01/2018
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/12/2021	10/01/2021		10/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/12/2021	10/01/2021		10/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/12/2021	10/01/2021		10/01/2021
Contract Detail	RITE AID DRUG PALACE, INC.	RITE AID #1809	222-14 LINDEN BOULEVARD	CAMBRIA HEIGHTS	NY	11411	07/13/2022	10/01/2022	08/21/2023	09/11/2023
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3677	162-19 HILLSIDE AVENUE	JAMAICA	NY	11432	07/03/2018	10/01/2018	03/27/2019	03/27/2019
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4274	90-01 SUTPHIN BOULEVARD	JAMAICA	NY	11435	07/03/2018	10/01/2018	03/27/2019	03/27/2019
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3581	85-10 NORTHERN BOULEVARD	JACKSON HEIGHTS	NY	11372	07/13/2022	10/01/2022	04/21/2025	04/24/2025
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4836	245-14 FRANCIS LEWIS BLVD	ROSEDALE	NY	11422	07/13/2022	10/01/2022	04/21/2025	04/24/2025
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4277	115-10 MERRICK BOULEVARD	JAMAICA	NY	11434	07/13/2022	10/01/2022	08/31/2023	09/05/2023
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4856	122-02 LIBERTY AVENUE	SOUTH RICHMOND HILL	NY	11419	07/13/2022	10/01/2022	04/21/2025	04/24/2025
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4991	109-07 101ST AVENUE	JAMAICA	NY	11419	07/13/2022	10/01/2022	04/21/2025	04/24/2025
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #2771	165-02 BAISLEY BOULEVARD	JAMAICA	NY	11434	07/13/2022	10/01/2022	04/21/2025	04/24/2025
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	04/13/2023	07/01/2023		07/01/2023
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	04/13/2023	07/01/2023		07/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05531	2195 MAGNOLIA STREET	ORANGEBURG	SC	29115	04/10/2019	07/01/2019		07/01/2019
Contract Detail	SREEPATHI PHARMACY INC	D/B/A METRO DRUGS	134-02 JAMAICA AVE	JAMAICA	NY	11418-2654	07/03/2018	10/01/2018	10/11/2022	10/12/2022
Contract Detail	TRINITY HOMECARE, L.L.C.	OPTION CARE	4805 METROPOLITAN AVE STE 3-02	RIDGEWOOD	NY	11385	01/15/2020	04/01/2020	10/12/2020	10/12/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	175-06 HILLSIDE AVE.	JAMAICA	NY	11432	10/12/2017	01/01/2018	11/21/2022	11/22/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04445	119-02 ROCKAWAY BLVD.	SOUTH OZONE PARK	NY	11420	10/12/2017	01/01/2018		10/12/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04565	12704 GUY R BREWER BLVD	JAMAICA	NY	11434	10/12/2017	01/01/2018		10/12/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02055	109-62 FRANCIS LEWIS BLVD	QUEENS VILLAGE	NY	11429	10/12/2017	01/01/2018		10/12/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS	1242 LIBERTY AVE.	BROOKLYN	NY	11208	10/12/2017	01/01/2018	02/22/2023	01/31/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04564	159-34 JAMAICA AVE	JAMAICA	NY	11432-6001	10/12/2017	01/01/2018	11/07/2023	01/31/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	132-50 METROPOLITAN AVE.	RICHMOND HILL	NY	11418	10/12/2017	01/01/2018		10/12/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05051	21914 MERRICK BLVD	LAURELTON	NY	11413	10/12/2017	01/01/2018		10/12/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	145-80 FARMERS BLVD.	JAMAICA	NY	11434	10/12/2017	01/01/2018	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	112-55 FARMERS BLVD.	JAMAICA	NY	11412	10/12/2017	01/01/2018	11/06/2019	02/13/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS # 17613	9001 SUTPHIN BLVD	JAMAICA	NY	11435	01/11/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17680	16040 CROSS BAY BLVD	HOWARD BEACH	NY	11414	01/11/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19035	16219 HILLSIDE AVE	JAMAICA	NY	11432	01/11/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17161	11910 LIBERTY AVE	S RICHMOND HILL	NY	11419-2002	04/10/2019	07/01/2019	12/05/2024	12/05/2024
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17979	78-14 LINDEN BLVD	HOWARD BEACH	NY	11414	04/10/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18412	9602 ROCKAWAY BLVD.	OZONE PARK	NY	11417	05/02/2019	05/02/2019		05/02/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/12/2017	01/01/2018		10/12/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/12/2017	01/01/2018	10/01/2021	10/04/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/12/2017	01/01/2018		10/12/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/12/2017	01/01/2018		10/12/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330014A	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER	133-03 JAMAICA AVENUE	RICHMOND HILLS	NY	Active
DSH330014C	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOLLIS)	188-03 Jamaica Avenue	HOLLIS	NY	Active
DSH330014D	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOWARD BEACH)	156-10 CROSSBAY BLVD.	HOWARD BEACH	NY	Active
DSH330014E	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (JAMAICA)	149-18 JAMAICA AVENUE	JAMAICA	NY	Active
DSH330014F	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (RICHMOND HILL)	133-03 JAMAICA AVENUE	RICHMOND HILL	NY	Active
DSH330014G	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014H	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS SENIOR HEALTH CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014K	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	The Jamaica Hospital Mental Health Clinic	90-09 VanWyck Expressway	JAMAICA	NY	Active
DSH330014L	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	130-02 115th Avenue	South Ozone Park	NY	Active
DSH330014M	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	207-01 116TH AVENUE	CAMBRIA HEIGHTS	NY	Active
DSH330014N	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	125-20 SUTPHIN BLVD	JAMAICA	NY	Active
DSH330014P	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	Jamaica Hospital Dental Clinic - Dental	134-20 Jamaica Ave	jamaica	NY	Active
DSH330014Q	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	St.Albans - clinic	111-20 Merrick Blvd	St.Albans	NY	Active
DSH330014R	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	East New York - OP Clinic	3080 Atlantic Ave	Brooklyn	NY	Active
DSH330014S	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	HOLLIS TUDOR - CLINIC	200-16 HOLLIS AVE	SAINT ALBANS	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Change Request	Unit Dose Sol ( Jamaica Hospital) 860 Aviation Pkwy Ste 400A Morrisville, NC 27560-7395		1/28/2025 7:27 AM
Addresses	Shipping Address	Insert	Change Request		JAMAICA HOSPITAL MEDICAL CENTER 89th Ave & Van Wyck Exp. JAMAICA, NY 11418	1/28/2025 7:27 AM
Addresses	Shipping Address	Insert	Change Request		JAMAICA HOSPITAL MEDICAL CENTER 8900 VAN WYCK EXPRESSWAY JAMAICA, NY 11418	1/28/2025 7:27 AM
Details	Last Recertification Date	Update	Recertification	8/15/2023 3:53:52 PM	8/15/2024 12:07:36 PM	8/15/2024 12:07 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 7:41:01 AM	8/15/2023 3:53:52 PM	8/15/2023 3:53 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 7:46:29 AM	9/8/2022 7:41:01 AM	9/8/2022 7:41 AM
Details	Last Recertification Date	Update	Recertification	9/5/2020 12:42:38 AM	8/24/2021 7:46:29 AM	8/24/2021 7:46 AM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/5/2020 12:42 AM
Details	Last Recertification Date	Update	Recertification	8/22/2019 5:34:45 AM	9/5/2020 12:42:38 AM	9/5/2020 12:42 AM
Details	Last Recertification Date	Update	Recertification	8/22/2018 2:09:43 PM	8/22/2019 5:34:45 AM	8/22/2019 5:34 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 7:47:52 PM	8/22/2018 2:09:43 PM	8/22/2018 2:09 PM
Contacts	Primary Contact	Update	Change Request	PANTALEO, NICHOLAS DIRECTOR OF PHARMACY Jamaica Hospital Medical Center 7182066090	Cosenza, Louis Director Jamaica Hospital Medical Center 7182066052	7/10/2018 10:31 AM
Addresses	Shipping Address	Insert	Change Request		Unit Dose Sol ( Jamaica Hospital) 860 Aviation Pkwy Ste 400A Morrisville, NC 27560-7395	6/19/2018 2:32 PM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/29/2017 7:47:52 PM	11/29/2017 7:47 PM
Contacts	Primary Contact	Update		PANTALEO, NICHOLAS DIRECTOR OF PHARMACY 7182066090	PANTALEO, NICHOLAS DIRECTOR OF PHARMACY Jamaica Hospital Medical Center 7182066090	10/3/2017 2:28 PM
Contacts	Authorizing Official	Update		DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/2/2017 2:49 PM
Contacts	Authorizing Official	Insert			DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	7/7/2017 3:56 PM
Contacts	Primary Contact	Insert			PANTALEO, NICHOLAS DIRECTOR OF PHARMACY 7182066090	6/26/2017 6:24 PM
Addresses	Main Address	Insert			8900 VAN WYCK EXPRESSWAY JAMAICA, NY 11418	3/3/2017 4:45 PM
Details	Last Recertification Date	Update		9/3/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/23/2016 9:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/13/2015 6:05 PM
Medicaid Billing	Medicaid: Number	Insert			00243852	10/13/2015 6:05 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/13/2015 6:05 PM
Medicaid Billing	NPI: Number	Insert			1245370717	9/3/2015 10:47 AM
Details	Last Recertification Date	Update		8/12/2014 12:00:00 AM	9/3/2015 12:00:00 AM	9/3/2015 10:47 AM
Details	Last Recertification Date	Update		9/5/2013 12:00:00 AM	8/12/2014 12:00:00 AM	8/12/2014 9:35 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 12:00:00 AM	9/5/2013 1:19 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/30/2012 7:28 AM
Details	Last Recertification Date	Insert				10/19/2006 12:32 PM
Details	Grant Number	Insert				10/19/2006 12:32 PM
Details	340B ID	Insert			DSH330014	10/19/2006 12:32 PM
Details	Is Authorizing Official EHB Data	Insert				10/19/2006 12:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/19/2006 12:32 PM
Details	Medicare Provider Number	Insert			330014	10/19/2006 12:32 PM
Details	Entity Name	Insert			JAMAICA HOSPITAL MEDICAL CENTER	10/19/2006 12:32 PM
Details	Program Code	Insert			DSH	10/19/2006 12:32 PM
Details	Entity Subname	Insert				10/19/2006 12:32 PM
Dates	Participating Approval Date	Insert			10/19/2006 12:00:00 AM	10/19/2006 12:32 PM
Details	State	Insert			Active	10/19/2006 12:32 PM
Dates	Registration Date	Insert			10/19/2006 12:00:00 AM	10/19/2006 12:32 PM
Dates	Signed By Date	Insert				10/19/2006 12:32 PM
Dates	Start Date	Insert			10/1/2004 12:00:00 AM	10/19/2006 12:32 PM
Terminations	Termination Comments	Insert				10/19/2006 12:32 PM
Terminations	Termination Date	Insert				10/19/2006 12:32 PM
Terminations	Termination Effective Date	Insert				10/19/2006 12:32 PM
Terminations	Termination Reason	Insert				10/19/2006 12:32 PM