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SREEPATHI PHARMACY INC
DSH330014K JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
The Jamaica Hospital Mental Health Clinic
Type
Disproportionate Share Hospital
340B ID
DSH330014K
Entity Address
90-09 VanWyck Expressway
JAMAICA, NY 11418
Medicare Provider Number
330014
Outpatient Facility Provider Number
Participating Start Date
7/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
SREEPATHI PHARMACY INC
Pharmacy Address
D/B/A METRO DRUGS
134-02 JAMAICA AVE
JAMAICA, NY 11418-2654
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291
Contract Pharmacy Representative
Sreepathi
Lavanya Akula, pharmacist
(718) 206-4653
Signed By Date
10/12/2018
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