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ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
DSH330169 MOUNT SINAI BETH ISRAEL
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Covered Entity Details
Entity Name
MOUNT SINAI BETH ISRAEL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330169
Entity Address
FIRST AVENUE AT 16TH STREET
NEW YORK, NY 10003
Medicare Provider Number
330169
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Pharmacy Address
ICAHN SCHOOL OF MEDICINE PHARMACY
1468 MADISON AVE
ANNENBERG-MC LEVEL
NEW YORK, NY 10029
Pharmacy Comments
Contract Details
Approval Date
4/4/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/27/2020
Ownership change
Contacts
Covered Entity Signing Official
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149
Contract Pharmacy Representative
Ichan School of Medicine Pharmacy
Jose Almonte, Assistant Director of Pharmacy
(212) 241-7720
Signed By Date
4/4/2019
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