Contract Pharmacy Details

GENOVESE DRUG STORES, INC.
DSH330014 JAMAICA HOSPITAL MEDICAL CENTER

Covered Entity Details

Entity Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330014

Entity Address

8900 VAN WYCK EXPRESSWAY
JAMAICA, NY 11418

Medicare Provider Number

330014

Participating Start Date

10/1/2004

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

GENOVESE DRUG STORES, INC.

Pharmacy Address

RITE AID #10608
96-02 ROCKAWAY BLVD.
OZONE PARK, NY 11417

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

10/14/2020
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

Walgreen
krystal mobley, Sr Analyst
(847) 964-8918

Signed By Date

1/11/2019

340B Drug Pricing Program Database