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AIDS HEALTHCARE FOUNDATION
DSH330101CQ NEW YORK-PRESBYTERIAN HOSPITAL
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Covered Entity Details
Entity Name
NEW YORK-PRESBYTERIAN HOSPITAL
Subdivision Name
COLUMBIA CLINIC SPECIALITIES
Type
Disproportionate Share Hospital
340B ID
DSH330101CQ
Entity Address
622 West 168th Street
VC,10th Floor
New York, NY 10032
Medicare Provider Number
330101
Outpatient Facility Provider Number
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
AIDS HEALTHCARE FOUNDATION
Pharmacy Address
AHF PHARMACY
619 MAIN ST
FARMINGDALE, NY 11735-4100
Pharmacy Comments
Contract Details
Approval Date
4/1/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Farrell, SVP, Finance
(212) 297-4358
Contract Pharmacy Representative
AIDS Healthcare Foundation
Barry Altstaedter, Director of Pharmacy Finance
(631) 870-5169
Signed By Date
4/1/2020
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