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909 COLUMBUS RX NY LLC
DSH330046 MOUNT SINAI WEST
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Covered Entity Details
Entity Name
MOUNT SINAI WEST
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330046
Entity Address
1000 TENTH AVENUE
NEW YORK, NY 10019
Medicare Provider Number
330046
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
909 COLUMBUS RX NY LLC
Pharmacy Address
D/B/A QUICKRX
909 COLUMBUS AVE
NEW YORK, NY 10025
Pharmacy Comments
Contract Details
Approval Date
7/9/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149
Contract Pharmacy Representative
Quick Rx Pharmacy Group
Elan Katz, CEO
(917) 733-4301
Signed By Date
7/9/2019
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