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RUSA RX PHARMACY CORP
DSH330080 LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
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Covered Entity Details
Entity Name
LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330080
Entity Address
234 EAST 149TH ST
BRONX, NY 10451
Medicare Provider Number
330080
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
RUSA RX PHARMACY CORP
Pharmacy Address
342 E 149TH ST
BRONX, NY 10451-5635
Pharmacy Comments
Contract Details
Approval Date
2/10/2019
Contract Begin Date
2/10/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/22/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Rusa RX Pharmacy Corp
Muhammad Rashid, Main POC
(718) 292-1212
Signed By Date
2/10/2019
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