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AVON PHARMACY & SURGICAL
DSH330204 BELLEVUE HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
BELLEVUE HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330204
Entity Address
462 FIRST AVENUE @ 27TH STREET
D/B/A NYC HEALTH & HOSPITAL CORP
NEW YORK, NY 10016
Medicare Provider Number
330204
Participating Start Date
8/1/1993
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
AVON PHARMACY & SURGICAL
Pharmacy Address
82 GRAHAM AVE
BROOKLYN, NY 11206
Pharmacy Comments
Contract Details
Approval Date
4/19/2019
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
AVON PHARMACY & SURGICAL
Alex Matthew, Pharmacist
(718) 388-4307 Ext: 7183840630
Signed By Date
4/19/2019
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