Contract Pharmacy Details

AMBER ENTERPRISES, INC
DSH330127 JACOBI MEDICAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

JACOBI MEDICAL CENTER (NYCHHC)

Subdivision Name

FORMERLY BRONX MUNICIPAL HOSPITAL

Type

Disproportionate Share Hospital

340B ID

DSH330127

Entity Address

1400 PELHAM PKWY SOUTH
BRONX, NY 10461

Medicare Provider Number

330127

Participating Start Date

12/1/1992

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

AMBER ENTERPRISES, INC

Pharmacy Address

DBA AMBER SPECIALTY PHARMACY
10004 S 152ND ST STE A
OMAHA, NE 68138-3931

Pharmacy Comments

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/25/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

Amber Enterprises
Kelley Miller, 340B Program Manager
(402) 861-7560

Signed By Date

7/17/2018

340B Drug Pricing Program Database