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CH02426M BRONX LEBANON INTEGRATED SERVICE SYSTEM INC (Terminated)
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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
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June 2025
June 2025
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