Contract Pharmacy Details

MY CHS RX INC.
DSH330259 MERCY MEDICAL CENTER

Covered Entity Details

Entity Name

MERCY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330259

Entity Address

1000 NORTH VILLAGE AVE
ROCKVILLE CENTRE, NY 11570

Medicare Provider Number

330259

Participating Start Date

1/1/2016

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

MY CHS RX INC.

Pharmacy Address

4295 HEMPSTEAD TPKE STE 14
BETHPAGE, NY 11714

Pharmacy Comments

Contract Details

Approval Date

1/9/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Morahan, VP- Finance
(516) 705-1317

Contract Pharmacy Representative

chs
nasser saad, avp pharmacy
(516) 705-2910

Signed By Date

1/9/2020