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WELCARE DRUG STORE INC
DSH330396 WOODHULL HOSPITAL CENTER
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Covered Entity Details
Entity Name
WOODHULL HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330396
Entity Address
760 BROADWAY
MAIN ENTRANCE: 720 FLUSHING AV
BROOKLYN, NY 11206
Medicare Provider Number
330396
Participating Start Date
12/1/1992
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WELCARE DRUG STORE INC
Pharmacy Address
D/B/A WELCARE PHARMACY
54 GRAHAM AVE
BROOKLYN, NY 11206-4066
Pharmacy Comments
Contract Details
Approval Date
10/4/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Welcare Drug Store
Igor Lipitz, Supervisor
(718) 599-7200
Signed By Date
10/4/2018
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