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JOLIN RX INC.
DSH330399 ST BARNABAS HOSPITAL
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Covered Entity Details
Entity Name
ST BARNABAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330399
Entity Address
4422 THIRD AVENUE
BRONX, NY 10457
Medicare Provider Number
330399
Participating Start Date
1/1/2005
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
JOLIN RX INC.
Pharmacy Address
DBA: JOLIN PHARMACY
1870 GRAND CONCOURSE
BRONX, NY 10457-5473
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ruth E. Cassidy, Senior Vice President of Clinical Support Services and Chief Pharmacy Officer
(718) 960-6180
Contract Pharmacy Representative
Jolin Rx
Rajesh Matthew, Pharmacist
(718) 294-5588
Signed By Date
1/14/2020
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