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NEWYORK-PRESBYTERIAN / QUEENS
DSH330101AJ NEW YORK-PRESBYTERIAN HOSPITAL
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Covered Entity Details
Entity Name
NEW YORK-PRESBYTERIAN HOSPITAL
Subdivision Name
PERINATAL CLINIC
Type
Disproportionate Share Hospital
340B ID
DSH330101AJ
Entity Address
21 Audubon Avenue
2nd Floor
New York, NY 10032
Medicare Provider Number
330101
Outpatient Facility Provider Number
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
NEWYORK-PRESBYTERIAN / QUEENS
Pharmacy Address
56-45 MAIN ST.
FLUSHING, NY 11355-5045
Pharmacy Comments
Contract Details
Approval Date
7/9/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Farrell, SVP, Finance
(212) 297-4358
Contract Pharmacy Representative
New York Presbyterian Queens
Kevin Paul Wilkin, Pharmacy Director
(718) 670-2894
Signed By Date
7/9/2019
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