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AN-NOOR PHARMACY INC
DSH330014L JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
JHMC-Extension Clinic
Type
Disproportionate Share Hospital
340B ID
DSH330014L
Entity Address
130-02 115th Avenue
South Ozone Park, NY 11420
Medicare Provider Number
330014
Outpatient Facility Provider Number
Participating Start Date
4/1/2017
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
AN-NOOR PHARMACY INC
Pharmacy Address
35 101ST AVE
BROOKLYN, NY 11208
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
Salaam Pharmacy
Mujjahid Huq, Owner
(718) 484-8157
Signed By Date
1/11/2019
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