340B Drug Pricing Program Database
MY CHS RX INC.
DSH330259 MERCY MEDICAL CENTER - information as of 4/28/2025 12:14:44 AM
Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330259
Entity Address
1000 NORTH VILLAGE AVE
ROCKVILLE CENTRE, NY 11570
Medicare Provider Number
330259
Participating Start Date
1/1/2016
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
MY CHS RX INC.
Pharmacy Address
4295 HEMPSTEAD TPKE STE 14
BETHPAGE, NY 11714
Pharmacy Comments
Contract Details
Approval Date
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Morahan, VP- Finance
(516) 705-1317
Contract Pharmacy Representative
chs
nasser saad, avp pharmacy
(516) 705-2910
Signed By Date
1/9/2020
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