Covered Entity Details

CH02426M BRONX LEBANON INTEGRATED SERVICE SYSTEM INC (Terminated) - information as of 6/6/2025 12:35:51 PM

Main Details

Name

BRONX LEBANON INTEGRATED SERVICE SYSTEM INC

Subdivision Name

BronxCare Health and Wellness Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013635

340B ID

CH02426M

Grant Number

H80CS00625

Additional Details

Current Program Status

Terminated

Registration Date

10/13/2014

Participating Start Date

1/1/2015

Participating Approval Date

10/24/2014

Last Recertification Date

2/12/2018

Termination Date
Termination Reason

7/1/2018
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Bronx Lebanon Hospital Center
VICTOR DEMARCO, CFO
(718) 901-8600

Primary Contact

Bronx-Lebanon Hospital Center
Lawrence Schiller, Director of Pharmacy
(718) 518-5021

Addresses

Street Address

199 MOUNT EDEN PKWY
BRONX, NY 10457-7703

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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	0476022
		1831515154

Shipping Addresses

Shipping Address 1

Bronx-Lebanon Hospital Center
1650 Grand Concourse
Bronx, NY 10457

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH02426A	Active	BPS-H80-003189	BronxCare Health Integrated Services System, Inc.	BronxCare Dr. Martin Luther King, Jr. Health Center	1265 Franklin Avenue	BRONX	NY
CH02426B	Terminated	BPS-H80-004751	BronxCare Health Integrated Services System, Inc.	BRONXCARE CROTONA PARK FAMILY PRACTICE	1591 Fulton Ave	Bronx	NY
CH02426C	Active	BPS-H80-005163	BronxCare Health Integrated Services System, Inc.	BronxCare MBD Family Practice	1690 Bryant Ave	Bronx	NY
CH02426E	Active	BPS-H80-001979	BronxCare Health Integrated Services System, Inc.	BronxCare Medical and Dental Center at Poe	2432 GRAND CONCOURSE	BRONX	NY
CH02426F	Terminated	BPS-H80-001633	BRONX LEBANON INTEGRATED SERVICE SYSTEM INC	BRONXCARE AT TIFFANY MEDICAL AND PEDIATRIC PRACTICE	853 Tiffany St	Bronx	NY
CH02426J	Active	BPS-H80-003449	BronxCare Health Integrated Services System, Inc.	BronxCare Third Avenue Medical and Dental Practice	2739-2745 3RD AVE	BRONX	NY
CH02426K	Active	BPS-H80-013572	BronxCare Health Integrated Services System, Inc.	BronxCare Dental Services	1775 GRAND CONCOURSE	Bronx	NY
CH02426L	Active	BPS-H80-010947	BronxCare Health Integrated Services System, Inc.	BronxCare Ogden Family Medical and Dental Center	1067 Ogden Avenue	Bronx	NY
CH02426M	Terminated	BPS-H80-013635	BRONX LEBANON INTEGRATED SERVICE SYSTEM INC	BronxCare Health and Wellness Center	199 MOUNT EDEN PKWY	BRONX	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH02426A	161 ST PHARMA INC	DBA-161 ST PHARMACY & SURGICAL SUPPLIES	275 E 161ST ST	BRONX	NY	10451-3504	01/01/2019
CH02426A	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	07/01/2016
CH02426A	BIOSCRIP PHARMACY NY, INC	DBA BIOSCRIP INFUSION SERVICES	1 VERMONT DRIVE	LAKE SUCCESS	NY	11042	01/02/2008	02/16/2021
CH02426B	BIOSCRIP PHARMACY NY, INC	DBA BIOSCRIP INFUSION SERVICES	1 VERMONT DRIVE	LAKE SUCCESS	NY	11042	07/01/2007	07/09/2019
CH02426A	BRIGHT PHARMA INC	142 E 170TH ST		BRONX	NY	10452-7021	01/01/2019
CH02426A	BRONX-MORRISANIA AMBULATORY	CARE UNIT-ATTN: PHARMACY DEPT	OF BRONX-LEBANON HOSPITAL CTR 1276 FULTON AVE 6TH FLOOR	BRONX	NY	10456	04/01/2014	04/09/2021
CH02426A	CORAM HEALTHCARE CORPORATION OF GREATER	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	48-23 55TH AVENUE	MASPETH	NY	11378	10/01/2017	07/02/2020
CH02426A	DRUG DEPOT CORP	619 E 169TH ST		BRONX	NY	10456-2605	01/01/2015
CH02426A	DRUG RITE PHARMACY INC	2426 GRAND CONCOURSE		BRONX	NY	10458	01/01/2019	07/02/2020
CH02426A	ELMHURST RX INC	557 E 169TH ST	D/B/A FULTON CARE PHARMACY	BRONX	NY	10456-2625	01/01/2021
CH02426A	FIRST HEALTH PHARMACY	PGU PHARMACY INC	1229 FRANKLIN AVE	BRONX	NY	10456	10/01/2017
CH02426A	FIRST HEALTH SPECIALTY PHARMACY INC.	754 E 151ST ST		BRONX	NY	10455-3267	10/01/2017	07/01/2018
CH02426A	GCC PHARMACY CORP	BRONX EDEN PHARMACY	1575 GRAND CONCOURSE	BRONX	NY	10452	10/01/2017	08/09/2017
CH02426A	JOLIN RX INC.	DBA: JOLIN PHARMACY	1870 GRAND CONCOURSE	BRONX	NY	10457-5473	01/01/2019
CH02426A	MORALES PHARMACY INC	DBA - MOSCOSO PHARMACY	1412-A JEROME AVE	BRONX	NY	10452	10/01/2017	06/19/2018
CH02426A	MORRISANIA PHARMACY INC.	D/B/A V V PHARMACY	3593 3RD AVE	BRONX	NY	10456	01/01/2019	07/02/2020
CH02426A	NUPTAM SERVICES INC	DBA: FAMILY PHARMACY AND SURGICAL SUPPLY	2754 3RD AVE	BRONX	NY	10455-4036	01/01/2021
CH02426A	PILGRIM PHARMACY INC	2941 WESTCHESTER AVE		BRONX	NY	10461-4534	10/01/2019
CH02426A	PRO VISTA SERVICES INC.	DBA FAMILY PHARMACY AND SURGICAL SUPPLY	2754 3RD AVE	BRONX	NY	10455-1045	01/01/2019	10/15/2020
CH02426A	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2017	07/02/2020
CH02426A	RS FARMA INC	A1 HEALTH PHAMACY	1003 OGDEN AVE	BRONX	NY	10452-5104	07/01/2020	03/16/2023
CH02426A	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	01/01/2024
CH02426A	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	01/01/2024
CH02426A	SOUTH BRONX RX INC.	1650 GRAND CONCOURSE		BRONX	NY	10457	04/01/2015
CH02426A	SS PHARMA INC.	DBA-RITE CHOICE PHARMACY	21 E 170TH ST	BRONX	NY	10452	01/01/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/1/2018 12:00:00 AM	4/4/2018 11:18 AM
Details	State	Update	Termination Request	Active	To Be Terminated	4/4/2018 11:18 AM
Terminations	Termination Date	Update	Termination Request		7/1/2018 12:00:00 AM	4/4/2018 11:18 AM
Terminations	Termination Effective Date	Update	Termination Request		7/1/2018 12:00:00 AM	4/4/2018 11:18 AM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	4/4/2018 11:18 AM
Details	Last Recertification Date	Update	Recertification	2/3/2017 12:00:00 AM	2/12/2018 2:44:24 PM	2/12/2018 2:44 PM
Contacts	Authorizing Official	Update		DEMARCO, VICTOR CFO 7189018600	DEMARCO, VICTOR CFO Bronx Lebanon Hospital Center 7189018600	11/16/2017 3:10 PM
Contacts	Signed By	Update		DEMARCO, VICTOR CFO 7189018600	DEMARCO, VICTOR CFO Bronx Lebanon Hospital Center 7189018600	11/16/2017 3:10 PM
Contacts	Primary Contact	Update		Schiller, Lawrence Director of Pharmacy 7185185021	Schiller, Lawrence Director of Pharmacy Bronx-Lebanon Hospital Center 7185185021	11/16/2017 11:20 AM
Contacts	Authorizing Official	Insert			DEMARCO, VICTOR CFO 7189018600	8/8/2017 2:04 PM
Contacts	Signed By	Insert			DEMARCO, VICTOR CFO 7189018600	8/8/2017 2:04 PM
Addresses	Main Address	Insert			199 MOUNT EDEN PKWY BRONX, NY 10457-7703	2/3/2017 4:24 PM
Contacts	Primary Contact	Update		Schiller, Lawrence Director of Pharmacy 7185185021	Schiller, Lawrence Director of Pharmacy 7185185021	2/3/2017 4:24 PM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/3/2017 12:00:00 AM	2/3/2017 4:24 PM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 11:26 AM
Medicaid Billing	NPI: Number	Insert			1831515154	2/10/2015 12:51 PM
Details	Last Recertification Date	Update			2/10/2015 12:00:00 AM	2/10/2015 12:51 PM
Addresses	Shipping Address	Insert			Bronx-Lebanon Hospital Center 1650 Grand Concourse Bronx, NY 10457	10/24/2014 2:09 PM
Contacts	Primary Contact	Insert			Schiller, Lawrence Director of Pharmacy 7185185021	10/24/2014 9:50 AM
Dates	Participating Approval Date	Update			10/24/2014 12:00:00 AM	10/24/2014 9:50 AM
Details	State	Update		Pending	Active	10/24/2014 9:50 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	10/24/2014 9:50 AM
Details	340B ID	Update		ONLINE_REG_47097	CH02426M	10/21/2014 10:39 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_47097	10/13/2014 12:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/13/2014 12:07 PM
Medicaid Billing	Medicaid: Number	Insert			0476022	10/13/2014 12:07 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/13/2014 12:07 PM
Details	Last Recertification Date	Insert				10/13/2014 12:07 PM
Details	Grant Number	Insert			H80CS00625	10/13/2014 12:07 PM
Details	340B ID	Insert			ONLINE_REG	10/13/2014 12:07 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/13/2014 12:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2014 12:07 PM
Details	Medicare Provider Number	Insert				10/13/2014 12:07 PM
Details	Entity Name	Insert			BRONX LEBANON INTEGRATED SERVICE SYSTEM INC	10/13/2014 12:07 PM
Details	Program Code	Insert			CH	10/13/2014 12:07 PM
Details	Entity Subname	Insert			BronxCare Health and Wellness Center	10/13/2014 12:07 PM
Dates	Participating Approval Date	Insert				10/13/2014 12:07 PM
Details	State	Insert			Pending	10/13/2014 12:07 PM
Dates	Registration Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 12:07 PM
Dates	Signed By Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 12:07 PM
Dates	Start Date	Insert				10/13/2014 12:07 PM
Terminations	Termination Comments	Insert				10/13/2014 12:07 PM
Terminations	Termination Date	Insert				10/13/2014 12:07 PM
Terminations	Termination Effective Date	Insert				10/13/2014 12:07 PM
Terminations	Termination Reason	Insert				10/13/2014 12:07 PM

340B Drug Pricing Program Database