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VILLAGE PHARMACY CORP
DSH330101 NEW YORK-PRESBYTERIAN HOSPITAL
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Covered Entity Details
Entity Name
NEW YORK-PRESBYTERIAN HOSPITAL
Subdivision Name
UNIVERSITY HOSP OF COLUMBIA & CORNELL
Type
Disproportionate Share Hospital
340B ID
DSH330101
Entity Address
525 East 68th Street
New York, NY 10065
Medicare Provider Number
330101
Participating Start Date
4/1/2003
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
VILLAGE PHARMACY CORP
Pharmacy Address
DBA VILLAGE APOTHECARY
407 BLEECKER ST
NEW YORK, NY 10014
Pharmacy Comments
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/9/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Farrell, SVP, Finance
(212) 297-4358
Contract Pharmacy Representative
Village Apothecary
Nirav Desai, President
(212) 807-7566
Signed By Date
10/16/2018
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