340B Drug Pricing Program Database
RITE AID OF NEW YORK, INC.
DSH330204 BELLEVUE HOSPITAL CENTER (NYCHHC) - information as of 5/8/2025 10:54:33 PM
Covered Entity Details
Entity Name
BELLEVUE HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330204
Entity Address
462 FIRST AVENUE @ 27TH STREET
D/B/A NYC HEALTH & HOSPITAL CORP
NEW YORK, NY 10016
Medicare Provider Number
330204
Participating Start Date
8/1/1993
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #3984
82-13 37TH AVENUE
JACKSON HEIGHTS, NY 11372
Pharmacy Comments
Contract Details
Approval Date
11/8/2012
Contract Begin Date
10/27/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/27/2012
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session