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TRINITY HOMECARE, L.L.C.
DSH330009 BronxCare Health System
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Covered Entity Details
Entity Name
BronxCare Health System
Subdivision Name
Fulton Division
Type
Disproportionate Share Hospital
340B ID
DSH330009
Entity Address
1276 FULTON AVE.
BRONX, NY 10456
Medicare Provider Number
330009
Participating Start Date
7/1/1993
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
TRINITY HOMECARE, L.L.C.
Pharmacy Address
OPTION CARE
4805 METROPOLITAN AVE STE 3-02
RIDGEWOOD, NY 11385
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
VICTOR DEMARCO, CFO
(718) 901-8600
Contract Pharmacy Representative
Option Care
Jenny Money, Manager, Health Systems Programs
(773) 202-6786
Signed By Date
1/15/2020
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