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AMERITA OF NEW YORK, LLC
DSH330024 THE MOUNT SINAI HOSPITAL
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Covered Entity Details
Entity Name
THE MOUNT SINAI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330024
Entity Address
ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029
Medicare Provider Number
330024
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
AMERITA OF NEW YORK, LLC
Pharmacy Address
D/B/A AMERITA
75 NASSAU TERMINAL RD
STE 100
NEW HYDE PARK, NY 11040-4997
Pharmacy Comments
Contract Details
Approval Date
10/4/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149
Contract Pharmacy Representative
Nextron Infusion Services
Simone Cimino, General Manager
(973) 575-0614
Signed By Date
10/4/2019
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