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ST. JOSEPH HOSPITAL
DSH330246 ST. CHARLES HOSPITAL
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Covered Entity Details
Entity Name
ST. CHARLES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330246
Entity Address
200 BELLE TERRE ROAD
PORT JEFFERSON, NY 11777
Medicare Provider Number
330246
Participating Start Date
1/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ST. JOSEPH HOSPITAL
Pharmacy Address
ATTN: PHARMACY DEPARTMENT
4295 HEMPSTEAD TPKE
BETHPAGE, NY 11714
Pharmacy Comments
Contract Details
Approval Date
10/1/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ronald Weingartner, VP
(631) 474-6600
Contract Pharmacy Representative
st charles
Ronald Weingartner, VP
(631) 474-6600
Signed By Date
10/1/2019
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