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JAY VIDHI PHARMACY LLC
DSH330208B ST JOHNS RIVERSIDE HOSPITAL
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Covered Entity Details
Entity Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
ARCHWAY
Type
Disproportionate Share Hospital
340B ID
DSH330208B
Entity Address
20 EAST 1ST STREET
MT VERNON, NY 10550
Medicare Provider Number
330208
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
JAY VIDHI PHARMACY LLC
Pharmacy Address
SUNLIGHT PHARMACY
967 N BROADWAY
YONKERS, NY 10701-1301
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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