Covered Entity Details

DSH330127 JACOBI MEDICAL CENTER (NYCHHC) (Active) - information as of 4/25/2025 8:31:06 PM

Main Details

Name

JACOBI MEDICAL CENTER (NYCHHC)

Subdivision Name

FORMERLY BRONX MUNICIPAL HOSPITAL

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330127

Medicare Provider Number

330127

Additional Details

Current Program Status

Active

Registration Date

9/12/2007

Participating Start Date

12/1/1992

Participating Approval Date

9/14/2007

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

NYC Health + Hospitals
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446

Primary Contact

NYC Health + Hospitals
Mark Capuano, Senior Director, Corporate Pharmacy 340B Program
(347) 835-9198

Addresses

Street Address

1400 PELHAM PKWY SOUTH
BRONX, NY 10461

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
8/4/05 UPADATED ADDR(WAS PELHAM PKWY & EASTCHESTER)	01/22/2010

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
CT	008036428,008102021	1679587679
NY	00246048	1679587679

Shipping Addresses

Shipping Address 1

NORTH CENTRAL BRONX HOSPITAL
3424 KOSSUTH AVENUE
C/O PHARMACY
BRONX, NY 10467

Shipping Address 2

JACOBI MEDICAL CENTER
1400 PELHAM PKWAY SOUTH
BRONX, NY 10461

Shipping Address 3

Safecor Health, LLC
317 New Boston Street, Suite 100
Woburn, MA 01801

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	1150 WEBSTER PHARMACY INC	D/B/A 167TH STREET PHARMACY	1150 WEBSTER AVE	BRONX	NY	10456-1045	01/17/2023	04/01/2023		04/01/2023
Contract Detail	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	10/16/2018	01/01/2019		03/11/2019
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/19/2016	01/01/2017		10/19/2016
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	10/13/2016	01/01/2017	07/19/2017	07/19/2017
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/13/2016	01/01/2017		10/13/2016
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/14/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/19/2016	01/01/2017		10/19/2016
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/19/2016	01/01/2017		10/19/2016
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/19/2016	01/01/2017	07/14/2023	07/14/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/14/2023	10/01/2023		10/01/2023
Contract Detail	ADEE PHARMACY INC	1427 E GUN HILL RD		BRONX	NY	10469	06/24/2021	06/25/2021		06/25/2021
Contract Detail	AMATO PHARMACY INC	619 E 187TH ST		BRONX	NY	10458-6706	04/10/2013	04/10/2013	02/12/2018	02/15/2018
Contract Detail	AMBER ENTERPRISES, INC	DBA AMBER SPECIALTY PHARMACY	10004 S 152ND ST STE A	OMAHA	NE	68138-3931	07/17/2018	10/01/2018	10/25/2018	10/26/2018
Contract Detail	AMBER ENTERPRISES, INC	DBA AMBER SPECIALTY PHARMACY	323 NORRISTOWN RD STE 100	AMBLER	PA	19002-2757	07/17/2018	10/01/2018	10/25/2018	10/26/2018
Contract Detail	AMBER SPECIALTY PHARMACY	AMBER ENTERPRISES INC	1301 E ARAPAHO RD, STE 103	RICHARDSON	TX	75081	07/17/2018	10/01/2018	10/25/2018	10/26/2018
Contract Detail	ARCHER PHARMACY INC.	D/B/A SAS PHARMACY	1481 LELAND AVE	BRONX	NY	10460-3901	07/01/2019	10/01/2019	11/02/2023	11/02/2023
Contract Detail	ARDENT PHARMACY INC.	D/B/A BENJAMIN'S PHARMACY & SURGICAL	987-989 ALLERTON AVE	BRONX	NY	10469	04/03/2013	04/03/2013	08/08/2023	08/11/2023
Contract Detail	AVS PHARMACY	D/B/A LEROY PHARMACY	314 E 204TH ST	BRONX	NY	10467	04/15/2013	04/15/2013		04/15/2013
Contract Detail	BCP PHARMACY INC	DBA: FALAK PHARMACY	2730 E TREMONT AVE	BRONX	NY	10461-2808	10/04/2019	01/01/2020		01/01/2020
Contract Detail	BEDFORD PHARMACY LLC	DBA: LEROY PHARMACY IV	387 BEDFORD PARK BLVD	BRONX	NY	10458-2422	06/24/2021	06/25/2021	07/15/2024	07/15/2024
Contract Detail	BELLEVUE HOSPITAL CENTER	462 1ST AVE		NEW YORK	NY	10016-9196	04/15/2020	04/17/2020		04/17/2020
Contract Detail	BEST AID COMMUNITY PHARMACY LLC	BEST AID PHARMACY	563 EAST TREMONT AVENUE	BRONX	NY	10457	10/15/2018	01/01/2019	03/18/2019	03/20/2019
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/13/2023	01/01/2024		01/01/2024
Contract Detail	BLONDELL RX CORP	D/B/A QUICK RX SPECIALTY PHARMACY	1642 EASTCHESTER ROAD	BRONX	NY	10461-2316	10/17/2022	01/01/2023		01/01/2023
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/17/2017	10/01/2017	01/26/2018	02/08/2018
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/15/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/08/2018	04/01/2018		01/08/2018
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/17/2017	10/01/2017	01/26/2018	02/08/2018
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/13/2017	10/01/2017	01/26/2018	02/08/2018
Contract Detail	CENTRAL PHARMACY GROUP INC	1ST AID PHARMACY & SURGICAL SUPPLIES	23 W FORDHAM RD	BRONX	NY	10468-5304	01/17/2023	04/01/2023	11/02/2023	11/02/2023
Contract Detail	CHARMAR INC	781 LYDIG AVE		BRONX	NY	10462	07/02/2014	10/01/2014	10/23/2015	10/29/2015
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	11 H COMMERCE WAY	TOTOWA	NJ	07512	10/04/2017	01/01/2018	01/11/2024	01/12/2024
Contract Detail	CORAM HEALTHCARE CORPORATION OF GREATER	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	48-23 55TH AVENUE	MASPETH	NY	11378	10/09/2017	01/01/2018	01/11/2024	01/12/2024
Contract Detail	CUMBERLAND DIAGNOSTIC & TREATMENT CENTER	NYC HEALTH & HOSPITAL CORPORATION	100 N PORTLAND AVE PHARMACY DEPARTMENT	BROOKLYN	NY	11205	04/15/2020	04/17/2020		04/17/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02437	732 ALLERTON AVENUE	BRONX	NY	10467	07/23/2014	10/01/2014		07/23/2014
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02433	2112 WHITE PLAINS ROAD	BRONX	NY	10462	07/23/2014	10/01/2014		07/23/2014
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03096	3775 E. TREMONT AVE.	BRONX	NY	10465	07/23/2014	10/01/2014		07/23/2014
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 07067	1916 WILLIAMSBRIDGE ROAD	BRONX	NY	10461	07/23/2014	10/01/2014		07/23/2014
Contract Detail	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY #8940	1688 WESTCHESTER AVE	BRONX	NY	10472	07/23/2014	10/01/2014		07/23/2014
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02697	3681 BRUCKNER BLVD.	BRONX	NY	10461	04/10/2019	07/01/2019	04/28/2022	05/23/2022
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02551	3125 BAINBRIDGE AVENUE	BRONX	NY	10467	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 8969	50-56 EAST 167TH ST.	BRONX	NY	10452	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 16921	40 W 225TH ST	BRONX	NY	10463	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 07066	565 WEST 235TH STREET	BRONX	NY	10463	04/10/2019	07/01/2019		07/01/2019
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02057	100-02 QUEENS BOULEVARD	FOREST HILLS	NY	11375	10/06/2019	01/01/2020		01/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02430	224 EAST 161ST STREET	BRONX	NY	10451	10/06/2019	01/01/2020	04/08/2022	05/23/2022
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02434	338 EAST 23RD ST.	NEW YORK	NY	10010	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05772	1500 LEXINGTON AVE.	NEW YORK	NY	10029	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02718	178-02 HILLSIDE AVE.	JAMAICA	NY	11432	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02438	282 EAST 149TH STREET	BRONX	NY	10451	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02700	1402 SHEEPSHEAD BAY ROAD	BROOKLYN	NY	11235	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02344	1249 NOSTRAND AVENUE	BROOKLYN	NY	11225	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 2280	329-339 WYCKOFF AVE	RIDGEWOOD	NY	11385	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02737	115 W. 125TH STREET	NEW YORK	NY	10027	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00491	7209 NORTHERN BLVD	JACKSON HEIGHTS	NY	11372	06/25/2020	07/01/2020		07/01/2020
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 06048	1933 VICTORY BLVD.	STATEN ISLAND	NY	10314	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 06049	1361 HYLAN BLVD.	STATEN ISLAND	NY	10305	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02769	4901 KINGS HIGHWAY	BROOKLYN	NY	11234	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 06047	640 ARTHUR KILL ROAD	STATEN ISLAND	NY	10308	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01113	89-11 NORTHERN BLVD.	JACKSON HEIGHTS	NY	11372	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03752	630 LEXINGTON AVENUE	NEW YORK	NY	10022	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02445	540 AMSTERDAM AVENUE	NEW YORK	NY	10024	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02164	211 EAST SANDFORD BLVD.	MOUNT VERNON	NY	10550	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00542	212-20 NORTHERN BOULEVARD	BAYSIDE	NY	11361	10/12/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01058	41-08 QUEENS BLVD.	SUNNYSIDE	NY	11104	10/17/2022	01/01/2023		01/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/17/2022	01/01/2023		01/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/09/2020	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	07/10/2017	10/01/2017		10/01/2017
Contract Detail	DB MEDICAL SUPPLIES INC	D/B/A CARE PHARMACY	979 WESTCHESTER AVE	BRONX	NY	10459	04/01/2019	07/01/2019		07/01/2019
Contract Detail	DBG SECURITY DRUGS INC.	D/B/A SECURITY DRUGS	3419 BOSTON RD	BRONX	NY	10469	07/01/2019	10/01/2019	10/15/2019	10/15/2019
Contract Detail	DD PHARMACY	DBA LEROY PHARMACY	1448 METROPOLITAN AVE	BRONX	NY	10462	01/17/2023	04/01/2023		04/01/2023
Contract Detail	DINESH PHARMACY	D/B/A MAHESH DRUGS	731 WHITE PLAINS RD	BRONX	NY	10473-2631	04/14/2023	07/01/2023		07/01/2023
Contract Detail	DRUG RITE II PHARMACY CORP	3432 #34 JEROME AVE		BRONX	NY	10467	04/16/2014	07/01/2014	12/04/2019	12/04/2019
Contract Detail	DRUG RITE PHARMACY INC	2426 GRAND CONCOURSE		BRONX	NY	10458	04/08/2014	07/01/2014	12/04/2019	12/04/2019
Contract Detail	DUANE READE	941 SOUTHERN BLVD #943		BRONX	NY	10459	04/16/2014	07/01/2014	10/03/2019	10/03/2019
Contract Detail	DUANE READE	1-13 EAST KINGSBRIDGE RD		BRONX	NY	10468	04/16/2014	07/01/2014	03/03/2020	04/15/2020
Contract Detail	DUANE READE	58 E. FORDHAM ROAD		BRONX	NY	10468	04/16/2014	07/01/2014	12/09/2021	12/17/2021
Contract Detail	DUANE READE		1888 WESTCHESTER AVENUE	BRONX	NY	10472	04/16/2014	07/01/2014	01/16/2018	01/19/2018
Contract Detail	DUANE READE	DBA: MELROSE PHARMACY	666 COURTLANDT AVE.	BRONX	NY	10451	04/16/2014	07/01/2014	11/18/2020	11/18/2020
Contract Detail	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	04/01/2019	07/01/2019	07/15/2024	07/15/2024
Contract Detail	EAST NEW YORK DIAGNOSTIC AND TREATMENT C	DIV OF NYC HEALTH & HOSP CORP	2094 PITKIN AVE	BROOKLYN	NY	11207	07/15/2021	10/01/2021		10/01/2021
Contract Detail	EAST TREMONT RX INC.	D/B/A EAST TREMONT PHARMACY	1065 E. TREMONT AVE	BRONX	NY	10460	10/02/2019	01/01/2020	07/15/2024	07/15/2024
Contract Detail	ELDER PHARMACY LLC	D/B/A LEROY PHARMACY	1527 WESTCHESTER AVE	BRONX	NY	10472-2908	10/15/2019	01/01/2020	07/15/2024	07/15/2024
Contract Detail	ELMHURST HOSPITAL CENTER	79-01 Broadway		Elmhurst	NY	11373	04/15/2020	04/17/2020		04/17/2020
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/03/2019	07/01/2019		07/01/2019
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/17/2018	10/01/2018		10/01/2018
Contract Detail	FORDHAM ROAD RX INC.	FORDHAM ROAD PHARMACY	2 E FORDHAM RD	BRONX	NY	10468-5445	01/17/2023	04/01/2023		04/01/2023
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10540	1710 CROSBY AVENUE	BRONX	NY	10461	11/08/2012	10/27/2012	03/13/2018	03/16/2018
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10575	2577 NOSTRAND AVENUE	BROOKLYN	NY	11210	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10539	2748 EAST. TREMONT AVE.	BRONX	NY	10461	11/08/2012	10/27/2012	02/07/2022	07/13/2022
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10544	3590 EAST TREMONT AVENUE	BRONX	NY	10465	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10574	7118 3RD AVENUE	BROOKLYN	NY	11209	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	GENOVESE DRUG STORES, INC.	RITE AID #10577	8222 18TH AVENUE	BROOKLYN	NY	11214	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	GOUVERNEUR DIAGNOSTIC & TREATMENT CENTER	ATTN: PHARMACY DEPARTMENT	227 MADISON ST	NEW YORK	NY	10002	07/15/2021	10/01/2021		10/01/2021
Contract Detail	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	04/15/2020	04/17/2020		04/17/2020
Contract Detail	JACOBI MEDICAL CENTER	NYC-HEALTH & HOSP.CORP	ATTN: PHARMACY DEPARTMENT 1400 PELHAM PKWY SOUTH	BRONX	NY	10461	04/15/2020	04/17/2020	01/10/2022	01/11/2022
Contract Detail	JADZ INC	MEDISERV PHARMACY	2611 WEBSTER AVE	BRONX	NY	10458	01/14/2019	04/01/2019		04/01/2019
Contract Detail	KHELLY NY II INC	D/B/A EASTCHESTER PHARMACY	2102 EASTCHESTER RD	BRONX	NY	10461-2248	04/08/2014	07/01/2014	07/15/2024	07/15/2024
Contract Detail	KING COMMUNITY PHARMACY INC.	165 DREISER LOOP		BRONX	NY	10475	04/18/2017	07/01/2017		04/18/2017
Contract Detail	KINGS COUNTY MED CNTR	C/O MAIN PHARMACY	451 CLARKSON AVE	BROOKLYN	NY	11203	04/15/2020	04/17/2020		04/17/2020
Contract Detail	KINGS PARK SLOPE INC	D/B/A KINGS SUPER PHARMACY	357 FLATBUSH AVE	BROOKLYN	NY	11238	06/24/2021	06/25/2021		06/25/2021
Contract Detail	KMN PHARMACY CORP	D/B/A OVAL PHARMACY	255 E GUN HILL RD	BRONX	NY	10467-2109	01/17/2023	04/01/2023		04/01/2023
Contract Detail	LEGEND DRUGS 1 LLC	159 E GUN HILL RD		BRONX	NY	10467-2106	04/15/2021	07/01/2021		07/01/2021
Contract Detail	LEMED PHARMACY III LLC	2417 3RD AVE	STE 406	BRONX	NY	10451-6340	04/09/2014	07/01/2014	11/02/2023	11/02/2023
Contract Detail	LEROY PHARMACY II LLC	239 E 198TH ST		BRONX	NY	10458-3147	07/17/2018	10/01/2018		10/01/2018
Contract Detail	LINCOLN MEDICAL & MENTAL HEALTH CENTER	234 E 149TH ST	CENTRAL PHARMACY	BRONX	NY	10451-5504	04/01/2019	07/01/2019		07/01/2019
Contract Detail	MEDLY PHARMACY INC.	DBA MEDLY PHARMACY	31 DEBEVOISE ST	BROOKLYN	NY	11206-4196	01/11/2022	04/01/2022	08/08/2023	08/11/2023
Contract Detail	METROPOLITAN HOSPITAL CENTER	ATTN: PHARMACY DEPARTMENT	1901 FIRST AVE	NEW YORK	NY	10029	04/15/2020	04/17/2020		04/17/2020
Contract Detail	MORRISANIA DIAGNOSTIC AND TREATMENT CENT	NEW YORK CITY HEALTH AND HOSPITAL CORPOR	1225 GERARD AVE	BRONX	NY	10452	07/17/2018	10/01/2018		10/01/2018
Contract Detail	MT CARMEL PHARMACY INC	705 E 187TH ST		BRONX	NY	10458-6803	04/03/2013	04/03/2013		04/04/2013
Contract Detail	NEW YORK CITY HEALTH AND HOSPITAL CORPOR	RENAISSANCE HEALTH CARE NETWORK	264 W 118TH ST	NEW YORK	NY	10026-1620	07/15/2021	10/01/2021		10/01/2021
Contract Detail	NORTH CENTRAL BRONX HOSPITAL	3424 KOSSUTH AVE	ATT PHARMACY DEPT	BRONX	NY	10467	04/15/2020	04/17/2020		04/17/2020
Contract Detail	NUPTAM SERVICES INC	DBA: FAMILY PHARMACY AND SURGICAL SUPPLY	2754 3RD AVE	BRONX	NY	10455-4036	10/17/2022	01/01/2023		01/01/2023
Contract Detail	NY DRUGS INC	DBA: CASTLE HILL COMMUNITY PHARMACY	706 CASTLE HILL AVE	BRONX	NY	10473	10/15/2018	01/01/2019	07/15/2024	07/15/2024
Contract Detail	NYC HEALTH + HOSPITALS / SOUTH BROOKLYN	CONEY ISLAND HOSPITAL	2601 OCEAN PKWY PHARMACY DEPARTMENT	BROOKLYN	NY	11235	04/15/2020	04/17/2020		04/17/2020
Contract Detail	NZONE PHARMACY LLC	102-10 101ST AVE		OZONE PARK	NY	11416	04/01/2019	07/01/2019	08/08/2023	08/11/2023
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/13/2018	10/01/2018		10/01/2018
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/17/2022	01/01/2023		01/01/2023
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/17/2022	01/01/2023		01/01/2023
Contract Detail	PAPAS PHARMACY LLC	3979 LACONIA AVE		BRONX	NY	10466-1046	07/02/2014	10/01/2014	10/23/2015	10/29/2015
Contract Detail	PARKARE PHARMACY INC	PARKARE PHARMACY, INC	2158 STARLING AVE	BRONX	NY	10462-4303	07/01/2019	10/01/2019		10/01/2019
Contract Detail	PARKCHESTER FAMILY PHARMACY & SURGICAL I	PARKCHESTER FAMILY PHARMACY AND SURGICAL	1445 UNIONPORT RD	BRONX	NY	10462-1046	04/14/2023	07/01/2023		07/01/2023
Contract Detail	PELHAM PHARMACY INC	PELHAM PHARMACY INC	2171 WHITE PLAINS RD	BRONX	NY	10462-1046	07/12/2019	10/01/2019	06/22/2022	07/13/2022
Contract Detail	PEOPLE'S DRUG RX INC	D/B/A PEOPLE'S PHARMACY AND FOODMART	3176 BAINBRIDGE AVE	BRONX	NY	10467-3980	06/24/2021	06/25/2021		06/25/2021
Contract Detail	PILGRIM PHARMACY INC	2941 WESTCHESTER AVE		BRONX	NY	10461-4534	11/06/2012	10/27/2012		03/28/2013
Contract Detail	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	04/18/2017	07/01/2017	10/05/2018	10/08/2018
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/10/2017	10/01/2017	08/31/2022	11/02/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/23/2014	10/01/2014	10/23/2015	10/29/2015
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/17/2017	04/01/2017		01/17/2017
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2919	126 EIGHTH AVE.	NEW YORK	NY	10011	01/15/2019	04/01/2019		04/01/2019
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	01/09/2020	04/01/2020		04/01/2020
Contract Detail	QUEENS HOSPITAL CENTER	1ST FLOOR NEW BUILDING	82-68 164TH ST PHARMACY DEPARTMENT	JAMAICA	NY	11432-1121	04/15/2020	04/17/2020		04/17/2020
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/13/2023	01/01/2024		01/01/2024
Contract Detail	RITE AID DRUG PALACE, INC.	RITE AID #1957	3040-44 EASTCHESTER ROAD	BRONX	NY	10469	11/08/2012	10/27/2012	03/13/2018	03/16/2018
Contract Detail	RITE AID DRUG PALACE, INC.	RITE AID #1845	3901 WHITE PLAINS ROAD	BRONX	NY	10466	11/08/2012	10/27/2012	03/13/2018	03/16/2018
Contract Detail	RITE AID OF NEW YORK		DBA RITE AID #4421 1998 BRUCKNER BLVD	BRONX	NY	10473	11/08/2012	10/27/2012	11/16/2015	11/17/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3980	1179 EAST 233RD STREET	BRONX	NY	10466	11/08/2012	10/27/2012	11/16/2015	11/17/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4258	1516-1518 WESTCHESTER AVENUE	BRONX	NY	10472	11/08/2012	10/27/2012	11/16/2015	11/17/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4428	186-16 UNION TURNPIKE	FLUSHING	NY	11366	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #549	2158 WHITE PLAINS ROAD	BRONX	NY	10462	11/08/2012	10/27/2012	03/13/2018	03/16/2018
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3812	239 EAST 198TH STREET	BRONX	NY	10458	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3774	2426-34 EASTCHESTER ROAD	BRONX	NY	10469	11/08/2012	10/27/2012	07/15/2024	07/15/2024
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #1665	2750 BOSTON ROAD	BRONX	NY	10469	11/08/2012	10/27/2012	03/13/2018	03/16/2018
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #424	3480 JEROME AVENUE	BRONX	NY	10467	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4294	4159 WHITE PLAINS ROAD	BRONX	NY	10466	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4618	4232 BAYCHESTER AVENUE	BRONX	NY	10466	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4667	49 WEST FORDHAM ROAD	BRONX	NY	10468	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4261	501 6TH AVENUE	NEW YORK	NY	10011	11/08/2012	10/27/2012	11/16/2015	11/17/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3663	592 EAST 183RD STREET	BRONX	NY	10458	11/08/2012	10/27/2012	10/18/2017	10/18/2017
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3363	650 CASTLE HILL AVENUE	BRONX	NY	10473	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3507	650 EAST TREMONT AVENUE	BRONX	NY	10457	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4790	691 CO-OP CITY BLVD STE L	BRONX	NY	10475	11/08/2012	10/27/2012	10/23/2015	10/29/2015
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3581	85-10 NORTHERN BOULEVARD	JACKSON HEIGHTS	NY	11372	11/08/2012	10/27/2012	09/25/2017	10/16/2017
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3858	901 EAST GUN HILL ROAD	BRONX	NY	10469	11/08/2012	10/27/2012	07/15/2024	07/15/2024
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #7910	925 SOUNDVIEW AVENUE	BRONX	NY	10473	11/08/2012	10/27/2012	03/13/2018	03/16/2018
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #2669	2063 BARTOW AVENUE	BRONX	NY	10475-4613	10/13/2016	01/01/2017		10/13/2016
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3359	911 MORRIS PARK AVENUE	BRONX	NY	10462	10/13/2016	01/01/2017	04/10/2025	04/14/2025
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4258	1516-1518 WESTCHESTER AVENUE	BRONX	NY	10472	10/13/2016	01/01/2017	10/25/2022	10/25/2022
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4618	4232 BAYCHESTER AVENUE	BRONX	NY	10466	10/13/2016	01/01/2017	03/13/2018	03/16/2018
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4667	49 WEST FORDHAM ROAD	BRONX	NY	10468	10/13/2016	01/01/2017	03/13/2018	03/16/2018
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #7906	840 WESTCHESTER AVE	BRONX	NY	10459	04/11/2019	07/01/2019	04/19/2022	07/13/2022
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #4294	4159 WHITE PLAINS ROAD	BRONX	NY	10466	04/11/2019	07/01/2019		07/01/2019
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3980	1179 EAST 233RD STREET	BRONX	NY	10466	04/11/2019	07/01/2019	07/15/2024	07/15/2024
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3663	592 EAST 183RD STREET	BRONX	NY	10458	04/11/2019	07/01/2019	07/15/2024	07/15/2024
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3363	650 CASTLE HILL AVENUE	BRONX	NY	10473	07/01/2019	10/01/2019	02/14/2022	07/13/2022
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3844	950-960 SOUTHERN BOULEVARD	BRONX	NY	10459	04/15/2021	07/01/2021		07/01/2021
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3817	57 EAST BURNSIDE AVENUE	BRONX	NY	10453	01/11/2022	04/01/2022	07/05/2022	07/11/2022
Contract Detail	RITE AIDE OF NEW YORK		RITE AID #2703 546-558 WEST 207TH STREET	NEW YORK	NY	10034-2611	11/08/2012	10/27/2012	11/16/2015	11/17/2015
Contract Detail	RITE-WAY PHARMACY	1603 WESTCHESTER AVE		BRONX	NY	10472-2914	10/05/2018	01/01/2019		01/01/2019
Contract Detail	RJ PHARMACY, INC.	2111 WILLIAMSBRIDGE RD		BRONX	NY	10461-1601	04/08/2014	07/01/2014		03/20/2019
Contract Detail	SEDGWICK PHARMACY INC	SEDGWICK PHARMACY	3887 SEDGWICK AVE	BRONX	NY	10463-1046	01/17/2023	04/01/2023		04/01/2023
Contract Detail	SEGUNDO RUIZ BELVIS DIAGNOSTIC & TREATME	D/B/A NEW YORK CITY H.H.C.	545 E 142ND ST	BRONX	NY	10454	07/15/2021	10/01/2021		10/01/2021
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	07/13/2018	10/01/2018		10/01/2018
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/15/2020	10/01/2020		10/01/2020
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	01/08/2018	04/01/2018	10/10/2024	10/15/2024
Contract Detail	STARLING PHARMACY INC.	STARLING PHARMACY	2098 STARLING AVE	BRONX	NY	10462	10/15/2019	01/01/2020		01/01/2020
Contract Detail	STAT RX PHARMACY, INC.	235 EAST 167TH STREET		BRONX	NY	10456	01/16/2018	04/01/2018		01/16/2018
Contract Detail	SUN PHARMA INC	DBA DEFRANCO PHARMACY	1790 RANDALL AVE	BRONX	NY	10473	10/15/2021	01/01/2022		01/01/2022
Contract Detail	SVP DRUGS CORP.	D/B/A SINAI RX PHARMACY	903B SHERIDAN AVE	BRONX	NY	10451	01/12/2024	04/01/2024	01/10/2025	01/13/2025
Contract Detail	TOTAL CARE PHARMACY BX INC	1721 CROSBY AVE	ATTN: SUPERVISING PHARMACIST	BRONX	NY	10461-4901	04/10/2013	04/10/2013	02/12/2018	02/13/2018
Contract Detail	TOTAL CARE RX, INC.	WORLD'S FAIR PHARMACY	22310 UNION TPKE	OAKLAND GARDENS	NY	11364-3645	01/16/2018	04/01/2018		01/16/2018
Contract Detail	TRUE NORTH HEALTH PHARMACY, INC	DBA: VIVO HEALTH PHARMACY AT CFAM	450 LAKEVILLE RD	LAKE SUCCESS	NY	11042	07/15/2019	10/01/2019		10/01/2019
Contract Detail	TRUE NORTH HEALTH PHARMACY, INC.	DBA: VIVO HEALTH SPECIALTY PHARMACY	225 COMMUNITY DR STE 100	GREAT NECK	NY	11021-5506	07/15/2019	10/01/2019		10/01/2019
Contract Detail	VALUE CARE RX INC.	D/B/A RITE CARE PHARMACY	805B SOUNDVIEW AVE	BRONX	NY	10473-3900	04/07/2022	07/01/2022		07/01/2022
Contract Detail	VEK SERVICE INC	D/B/A SINAI RX PHARMACY	903B SHERIDAN AVE	BRONX	NY	10451-3305	04/07/2022	07/01/2022	07/15/2024	07/15/2024
Contract Detail	WALGREEN EASTERN CO. INC.	DBA: WALGREENS	244 E 161ST STREET	BRONX	NY	10451	07/11/2022	10/01/2022		10/01/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01013	5564 BROADWAY	BRONX	NY	10463	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01918	755 BROADWAY	BROOKLYN	NY	11206-5320	04/16/2014	07/01/2014	11/01/2019	11/04/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05074	55 WESTCHESTER SQUARE	BRONX	NY	10461	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07627	3575 BOSTON RD	BRONX	NY	10469-2518	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	4401 WHITE PLAINS RD.	BRONX	NY	10470	04/16/2014	07/01/2014	03/12/2020	04/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10411	406 E. FORDHAM RD.	BRONX	NY	10458	04/16/2014	07/01/2014	01/10/2025	01/13/2025
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1031 WESTCHESTER AVE.	BRONX	NY	10459	04/16/2014	07/01/2014	08/10/2020	10/02/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10989	2431 BOSTON RD.	BRONX	NY	10467-9067	04/16/2014	07/01/2014	07/15/2024	07/15/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11172	1371 METROPOLITAN AVE.	BRONX	NY	10462-7403	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2504 EASTCHESTER RD.	BRONX	NY	10469-5902	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1820 WILLIAMSBRIDGE RD.	BRONX	NY	10461	04/16/2014	07/01/2014	11/15/2022	08/11/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	3085 E TREMONT AVE	BRONX	NY	10461-5720	04/16/2014	07/01/2014	07/15/2024	07/15/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1612 WESTCHESTER AVE	BRONX	NY	10472	04/16/2014	07/01/2014	11/14/2022	08/11/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16512	3462 JEROME AVE.	BRONX	NY	10467	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16078	205 8TH AVENUE	NEW YORK	NY	10011	07/10/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS # 18988	2750 BOSTON RD	BRONX	NY	10469	03/29/2018	03/29/2018		04/03/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19196	3040-44 EASTCHESTER RD	BRONX	NY	10469	03/29/2018	03/29/2018	11/14/2022	08/11/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17926	4232 BAYCHESTER AVE	BRONX	NY	10466	03/29/2018	03/29/2018	04/10/2025	04/14/2025
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS # 18215	49 W FORDHAM RD	BRONX	NY	10468	03/29/2018	03/29/2018		04/03/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17511	925 SOUNDVIEW AVENUE	BRONX	NY	10473	03/29/2018	03/29/2018		04/03/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18198	1710 CROSBY AVE	BRONX	NY	10461	04/02/2018	03/29/2018		04/03/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17828	3901 WHITE PLAINS ROAD	BRONX	NY	10466	04/02/2018	03/29/2018	11/17/2022	08/11/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS 19458	2158 WHITE PLAINS ROAD	BRONX	NY	10462	04/02/2018	03/29/2018	12/21/2021	02/21/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16463	29 W. 116TH ST.	NEW YORK	NY	10026	07/11/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18322	3012 3RD AVE	BRONX	NY	10455	07/11/2018	10/01/2018	11/08/2022	08/11/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17499	691 CO-OP CITY BLVD UNIT L	BRONX	NY	10475-1673	07/11/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS # 17665	3480 JEROME AVENUE	BRONX	NY	10467-1002	07/11/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19195	650 E TREMONT AVE	BRONX	NY	10457	07/13/2018	10/01/2018	11/09/2022	08/11/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18990	3590 E TREMONT AVE	BRONX	NY	10465	01/11/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: COMMUNITY, A WALGREENS PHARMACY #16	3954 BROADWAY	NEW YORK	NY	10032	06/30/2020	07/01/2020	04/12/2024	04/15/2024
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY #16511	306 CLARKSON AVE.	BROOKLYN	NY	11226	06/30/2020	07/01/2020		07/01/2020
Contract Detail	WALGREEN EASTERN CO., INC.	COMMUNITY, A WALGREENS PHARMACY #16530	7512 BROADWAY	ELMHURST	NY	11373	06/30/2020	07/01/2020	07/15/2024	07/15/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: COMMUNITY, A WALGREENS PHARMACY #2	66 E. POST RD 1ST FLOOR	WHITE PLAINS	NY	10601	06/30/2020	07/01/2020	10/10/2024	10/15/2024
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17604	541 W 235TH ST	BRONX	NY	10463	01/04/2021	04/01/2021		04/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19889	32 E 170TH STREET	BRONX	NY	10452	01/04/2021	04/01/2021		04/01/2021
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/16/2014	07/01/2014	08/20/2015	09/04/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/16/2014	07/01/2014	01/08/2018	01/08/2018
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/03/2017	01/01/2018		10/03/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/16/2014	07/01/2014	10/01/2021	10/15/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/16/2014	07/01/2014		04/16/2014
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/09/2017	01/01/2018	11/01/2019	11/04/2019
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/04/2021	04/01/2021		04/01/2021
Contract Detail	WEBSTER DRUGS INC	D/B/A/ FARMACIA APOTEK	753 E TREMONT AVE	BRONX	NY	10457	10/05/2018	01/01/2019	04/17/2019	04/19/2019
Contract Detail	WOODHULL MEDICAL & MNTL HLTH	C/O PHARMACY	760 BROADWAY RM 1B-260	BROOKLYN	NY	11206	04/15/2020	04/17/2020		04/17/2020
Contract Detail	ZAMZAM DRUGS, INC.	3105 BAINBRIDGE AVE		BRONX	NY	10467	10/15/2021	01/01/2022		01/01/2022

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330127A	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	Gun Hill Health Center	1012 East Gunhill Road	Bronx	NY	Terminated
DSH330127B	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Emergency Department - Emergency Medicine	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127C	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Operating Room - Operating Room	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127D	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Recovery Room - Recovery Room	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127E	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Labor and Delivery - Labor and Delivery	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127F	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Radiology Diagnostic - Radiology Diagnostic	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127G	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ CT Scan - CT Scan	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127H	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Outpatient Clinic - Outpatient Clinic	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127J	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB_ Mental Health ACT Programs - Mental Health ACT Programs	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127K	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB_ Ambulatory Surgical Services - Ambulatory Surgical Services	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127L	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB_ Mental Health Clinic - Mental Health Clinic	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127M	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Medical Clinic - Medical Clinic - Medical Clinic	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127N	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Virology - Virology - Virology	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127P	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Surgical Clinic - Surgical Clinic - Surgical Clinic	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127Q	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Gynecology - Gynecology - Gynecology	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127R	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Obstetrics - Obstetrics - Obstetrics	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127S	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Rehabilitation Medicine - Rehabilitation Medicine - Rehabilitation Medicine	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127T	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Pediatrics - Pediatrics - Pediatrics	3424 Kossuth Avenue	Bronx	NY	Active
DSH330127U	Child	DSH	JACOBI MEDICAL CENTER (NYCHHC)	NCB _ Family Planning - Family Planning - Family Planning	3424 Kossuth Avenue	Bronx	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Brown, Deborah Alyse Senior Vice President, External and Regulatory Affairs NYC Health + Hospitals 3479470446	Brown, Deborah Alyse Senior Vice President, Chief External Affairs Officer NYC Health + Hospitals 3479470446	11/15/2024 1:26 PM
Details	Last Recertification Date	Update	Recertification	8/29/2023 2:23:45 PM	9/3/2024 2:51:28 PM	9/3/2024 2:51 PM
Addresses	Shipping Address	Insert	Change Request		Safecor Health, LLC 317 New Boston Street, Suite 100 Woburn, MA 01801	3/27/2024 7:45 AM
Details	Last Recertification Date	Update	Recertification	9/2/2022 12:45:08 PM	8/29/2023 2:23:45 PM	8/29/2023 2:23 PM
Details	Last Recertification Date	Update	Recertification	8/27/2021 1:30:53 PM	9/2/2022 12:45:08 PM	9/2/2022 12:45 PM
Contacts	Primary Contact	Update	Group Change Request	Than, Min Assistant Vice President New York City Health and Hospitals 2124423854	Capuano, Mark Senior Director, Corporate Pharmacy 340B Program NYC Health + Hospitals 3478359198	8/23/2022 7:17 AM
Contacts	Authorizing Official	Update	AO Change Request	Albertson, Paul Vice President New York City Health and Hospitals 2127482256	Brown, Deborah Alyse Senior Vice President, External and Regulatory Affairs NYC Health + Hospitals 3479470446	8/16/2022 7:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/22/2022 6:38 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008036428	2/22/2022 6:38 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	2/22/2022 6:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/22/2022 6:38 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008102021	2/22/2022 6:38 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	2/22/2022 6:38 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1679587679	2/22/2022 6:38 PM
Medicaid Billing	NPI: State	Insert	Change Request		CT	2/22/2022 6:38 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 11:40:33 AM	8/27/2021 1:30:53 PM	8/27/2021 1:30 PM
Contacts	Primary Contact	Update	Profile Change Request	Than, Min Sr. Director New York City Health and Hospitals 2124423854	Than, Min Assistant Vice President New York City Health and Hospitals 2124423854	8/24/2021 6:37 PM
Addresses	Shipping Address	Insert	Change Request		NORTH CENTRAL BRONX HOSPITAL 3424 KOSSUTH AVENUE C/O PHARMACY BRONX, NY 10467	5/25/2021 1:54 PM
Addresses	Shipping Address	Insert	Change Request		JACOBI MEDICAL CENTER 1400 PELHAM PKWAY SOUTH BRONX, NY 10461	5/25/2021 1:54 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/4/2020 11:40 AM
Details	Last Recertification Date	Update	Recertification	9/2/2019 4:14:25 PM	9/4/2020 11:40:33 AM	9/4/2020 11:40 AM
Contacts	Primary Contact	Update	Change Request	Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	Than, Min Sr. Director New York City Health and Hospitals 2124423854	2/4/2020 5:24 PM
Addresses	Main Address	Update	Recertification	1400 PELHAM PKWY S BRONX, NY 10461	1400 PELHAM PKWY SOUTH BRONX, NY 10461	9/2/2019 4:14 PM
Details	Last Recertification Date	Update	Recertification	9/12/2018 4:03:10 PM	9/2/2019 4:14:25 PM	9/2/2019 4:14 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 10:03:33 PM	9/12/2018 4:03:10 PM	9/12/2018 4:03 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/15/2017 10:03:33 PM	11/15/2017 10:03 PM
Contacts	Authorizing Official	Update	Profile Change Request	Albertson, Paul Vice President Elmhurst Hospital 2127482256	Albertson, Paul Vice President New York City Health and Hospitals 2127482256	9/21/2017 5:59 PM
Contacts	Authorizing Official	Update	Change Request	Albertson, Paul Vice President 2127482256	Albertson, Paul Vice President Elmhurst Hospital 2127482256	9/20/2017 11:54 AM
Contacts	Primary Contact	Update		Sestito, Danielle Senior Director, 340B Operations 2124423892	Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	9/18/2017 1:24 PM
Contacts	Authorizing Official	Insert			Albertson, Paul Vice President 2127482256	8/14/2017 11:29 AM
Contacts	Primary Contact	Update		D'AGOSTINO, JOSEPH DIRECTOR OF PHARMACY 7189184550	Sestito, Danielle Senior Director, 340B Operations 2124423892	8/14/2017 11:29 AM
Addresses	Main Address	Insert			1400 PELHAM PKWY S BRONX, NY 10461	8/14/2017 11:28 AM
Contacts	Primary Contact	Insert			D'AGOSTINO, JOSEPH DIRECTOR OF PHARMACY 7189184550	5/11/2017 10:19 AM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 10:57 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/6/2015 10:47 AM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/6/2015 10:47 AM
Details	Last Recertification Date	Update		9/12/2013 12:00:00 AM	8/27/2014 12:00:00 AM	8/27/2014 1:53 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/12/2013 12:00:00 AM	9/12/2013 8:39 PM
Medicaid Billing	NPI: Number	Insert			1679587679	5/16/2012 8:10 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/16/2012 8:10 AM
Details	Last Recertification Date	Insert				1/22/2010 3:59 PM
Details	Grant Number	Insert				1/22/2010 3:59 PM
Details	340B ID	Insert			DSH330127	1/22/2010 3:59 PM
Details	Is Authorizing Official EHB Data	Insert				1/22/2010 3:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/22/2010 3:59 PM
Details	Medicare Provider Number	Insert			330127	1/22/2010 3:59 PM
Details	Entity Name	Insert			JACOBI MEDICAL CENTER (NYCHHC)	1/22/2010 3:59 PM
Details	Program Code	Insert			DSH	1/22/2010 3:59 PM
Details	Entity Subname	Insert			FORMERLY BRONX MUNICIPAL HOSPITAL	1/22/2010 3:59 PM
Dates	Participating Approval Date	Insert			9/14/2007 12:00:00 AM	1/22/2010 3:59 PM
Details	State	Insert			Active	1/22/2010 3:59 PM
Dates	Registration Date	Insert			9/12/2007 12:00:00 AM	1/22/2010 3:59 PM
Dates	Signed By Date	Insert			8/2/2005 12:00:00 AM	1/22/2010 3:59 PM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	1/22/2010 3:59 PM
Terminations	Termination Comments	Insert				1/22/2010 3:59 PM
Terminations	Termination Date	Insert				1/22/2010 3:59 PM
Terminations	Termination Effective Date	Insert				1/22/2010 3:59 PM
Terminations	Termination Reason	Insert				1/22/2010 3:59 PM
Details	Comments Public	Insert			8/4/05 UPADATED ADDR(WAS PELHAM PKWY & EASTCHESTER)	1/22/2010 3:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/12/2007 7:47 PM
Medicaid Billing	Medicaid: Number	Insert			00246048	9/12/2007 7:47 PM
Medicaid Billing	Medicaid: State	Insert			NY	9/12/2007 7:47 PM