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APTEKA RX INC
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
HARLEM HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330240
Entity Address
506 LENOX AVENUE
NEW YORK, NY 10037
Medicare Provider Number
330240
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
APTEKA RX INC
Pharmacy Address
DBA-AMSTERDAM PHARMACY & SURGICAL SUPPLI
1743 AMSTERDAM AVE
NEW YORK, NY 10031-1003
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
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Apteka Rx
Ratna Ravulapalli, Manager
(212) 234-8850 Ext: 2122347400
Signed By Date
7/9/2019
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