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HISPANIOLA PHARMACEUTICAL GROUP INC
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
HISPANIOLA PHARMACEUTICAL GROUP INC
Pharmacy Address
D/B/A SOUTH BRONX PHARMACY
411 EAST 138TH STREET
BRONX, NY 10454
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/26/2019
Ownership change
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Hispaniola Pharmaceutical Group
Kouru Srinivas, President
(718) 401-7900
Signed By Date
4/11/2019
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