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CROSSBAY CHEMISTS CORP
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
CROSSBAY CHEMISTS CORP
Pharmacy Address
D/B/A CROSS BAY CHEMIST
157-02 CROSSBAY BLVD
HOWARD BEACH, NY 11414-2753
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
6/1/2021
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
jamaica
Frank Pantina, Pharmacist
(718) 659-9500
Signed By Date
1/11/2019
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