340B Drug Pricing Program Database
ACARIAHEALTH PHARMACY #12, INC.
DSH330024A THE MOUNT SINAI HOSPITAL - information as of 5/13/2025 11:27:18 PM
Covered Entity Details
Entity Name
THE MOUNT SINAI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330024A
Entity Address
25-10 30TH AVENUE
LONG ISLAND CITY, NY 11102
Medicare Provider Number
330024
Outpatient Facility Provider Number
Participating Start Date
7/1/2006
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY #12, INC.
Pharmacy Address
5 SKYLINE DR STE 240
HAWTHORNE, NY 10532-2166
Pharmacy Comments
Contract Details
Approval Date
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SALVATORE MORELLO, DIRECTOR OF FINANCE
(718) 267-4203
Contract Pharmacy Representative
Acaria Health
Ed Ochoa, Pharmacist-in-charge
(800) 511-5144
Signed By Date
4/13/2016
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