340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
31ST & 3RD PHARMACY INC
DSH330055R NEWYORK-PRESBYTERIAN / QUEENS
Print
Covered Entity Details
Entity Name
NEWYORK-PRESBYTERIAN / QUEENS
Subdivision Name
NYP/Queens Wound Healing Center
Type
Disproportionate Share Hospital
340B ID
DSH330055R
Entity Address
144-45 87th Avenue
Briarwood, NY 11435
Medicare Provider Number
330055
Outpatient Facility Provider Number
330055
Participating Start Date
1/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
31ST & 3RD PHARMACY INC
Pharmacy Address
D/B/A AVITA PHARMACY 1063
1860 WALT WHITMAN RD STE 700
MELVILLE, NY 11747
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/10/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476
Contract Pharmacy Representative
Paramount SPecialty
Al DosSantos, Founding Principle
(631) 815-5776
Signed By Date
1/11/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session