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MERU PHARMACY INC
DSH330208H ST JOHNS RIVERSIDE HOSPITAL
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Covered Entity Details
Entity Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
GREENBURGH ATS & HOMELESS SHELTER
Type
Disproportionate Share Hospital
340B ID
DSH330208H
Entity Address
30 MANHATTAN AVENUE
WHITE PLAINS, NY 10607
Medicare Provider Number
330208
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MERU PHARMACY INC
Pharmacy Address
DBA SUNRISE PHARMACY
2 PARK AVE
YONKERS, NY 10703-3402
Pharmacy Comments
Contract Details
Approval Date
7/29/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tara Curtin-Paloka, Vice President and Chief Nursing Officer
(914) 964-4789
Contract Pharmacy Representative
Sunrise Pharmacy
Pravin Patel, Supervising Pharmacist
(914) 964-1122
Signed By Date
7/15/2019
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