340B Drug Pricing Program Database
RAEES PHARMACY OF BKLYN
DSH330202 KINGS COUNTY HOSPITAL CENTER (NYCHHC) - information as of 6/27/2025 12:53:20 AM
Covered Entity Details
Entity Name
KINGS COUNTY HOSPITAL CENTER (NYCHHC)
Subdivision Name
MAIN
Type
Disproportionate Share Hospital
340B ID
DSH330202
Entity Address
451 CLARKSON AVE.
BROOKLYN, NY 11203
Medicare Provider Number
330202
Participating Start Date
12/1/1992
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
RAEES PHARMACY OF BKLYN
Pharmacy Address
750 FLATBUSH AVENUE
BROOKLYN, NY 11226
Pharmacy Comments
Contract Details
Approval Date
4/2/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/12/2017
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
Mohammed Ali, Owner
(718) 856-5998
Signed By Date
4/2/2015
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