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MERU PHARMACY INC
DSH330208F ST JOHNS RIVERSIDE HOSPITAL
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Covered Entity Details
Entity Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
NEW FOCUS CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330208F
Entity Address
70 ASHBURTON AVENUE
YONKERS, NY 10701
Medicare Provider Number
330208
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
Last Recertification Date
9/6/2023
Entity Termination Date
10/1/2024
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
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
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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