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RUTLAND PHARMACY LLC
DSH330202 KINGS COUNTY HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
KINGS COUNTY HOSPITAL CENTER (NYCHHC)
Subdivision Name
MAIN
Type
Disproportionate Share Hospital
340B ID
DSH330202
Entity Address
451 CLARKSON AVE.
BROOKLYN, NY 11203
Medicare Provider Number
330202
Participating Start Date
12/1/1992
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
RUTLAND PHARMACY LLC
Pharmacy Address
964 RUTLAND RD
BROOKLYN, NY 11212-1544
Pharmacy Comments
Contract Details
Approval Date
4/1/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Rutland Pjarmacy
Rao Nadendla, Manager
(718) 774-9613
Signed By Date
4/1/2019
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