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CRYSTAL DRUGS INC
DSH330350 UNIVERSITY HOSPITAL OF BROOKLYN
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL OF BROOKLYN
Subdivision Name
SUNY DOWNSTATE MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330350
Entity Address
445 LENOX ROAD
Attn: Pharmacy Box 36
BROOKLYN, NY 11203
Medicare Provider Number
330350
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CRYSTAL DRUGS INC
Pharmacy Address
MICHAEL'S PHARMACY
163 LINDEN BLVD
BROOKLYN, NY 11226
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Bayard Miller, Chief Financial OIfficer
(718) 270-4901
Contract Pharmacy Representative
Crystal Drugs Inc
Asif Iqtidar, President
(718) 921-8777 Ext: 7182842199
Signed By Date
4/15/2019
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