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JODINE PHARMACEUTICAL CORP.
DSH330396 WOODHULL HOSPITAL CENTER
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Covered Entity Details
Entity Name
WOODHULL HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330396
Entity Address
760 BROADWAY
MAIN ENTRANCE: 720 FLUSHING AV
BROOKLYN, NY 11206
Medicare Provider Number
330396
Participating Start Date
12/1/1992
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
JODINE PHARMACEUTICAL CORP.
Pharmacy Address
DBA MISHKIN PHARMACY
1127 BROADWAY
BROOKLYN, NY 11221
Pharmacy Comments
Contract Details
Approval Date
4/3/2019
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
JODINE PHARMACEUTICAL GROUP
Mulokandov Abo, Pharmacist
(718) 452-3261
Signed By Date
4/3/2019
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