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PRIMARY CARE PHARMACY INC
DSH330014C JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
MEDISYS FAMILY CARE CENTER (HOLLIS)
Type
Disproportionate Share Hospital
340B ID
DSH330014C
Entity Address
188-03 Jamaica Avenue
HOLLIS, NY 11423
Medicare Provider Number
330014
Outpatient Facility Provider Number
Participating Start Date
9/1/2008
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
PRIMARY CARE PHARMACY INC
Pharmacy Address
90-20 SUTPHIN BLVD
JAMAICA, NY 11435
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291
Contract Pharmacy Representative
Jamaica
Aleksandr Khaimov, Pharmacist
(718) 291-4747
Signed By Date
1/11/2019
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