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TOTAL CARE RX, INC.
DSH330055R NEWYORK-PRESBYTERIAN / QUEENS
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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
TOTAL CARE RX, INC.
Pharmacy Address
WORLD'S FAIR PHARMACY
22310 UNION TPKE
OAKLAND GARDENS, NY 11364-3645
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476
Contract Pharmacy Representative
Totalcarerx, inc
William Donnelly, Vice President
(718) 762-7111
Signed By Date
1/15/2019
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