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RITE AID OF NEW YORK, INC.
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
HARLEM HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330240
Entity Address
506 LENOX AVENUE
NEW YORK, NY 10037
Medicare Provider Number
330240
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #3663
592 EAST 183RD STREET
BRONX, NY 10458
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/10/2019
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