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SHANTI PHARMACYCORP
DSH330350 UNIVERSITY HOSPITAL OF BROOKLYN
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL OF BROOKLYN
Subdivision Name
SUNY DOWNSTATE MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330350
Entity Address
445 LENOX ROAD
Attn: Pharmacy Box 36
BROOKLYN, NY 11203
Medicare Provider Number
330350
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
SHANTI PHARMACYCORP
Pharmacy Address
D/B/A SILVER ROD DRUGS
5105 CHURCH AVE
BROOKLYN, NY 11203
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Bayard Miller, Chief Financial OIfficer
(718) 270-4901
Contract Pharmacy Representative
Shanti Pharmacy Corp
Milind Suvarnakar, Owner
(718) 922-3400
Signed By Date
1/3/2019
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