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MT CARMEL PHARMACY INC
DSH330059 MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330059
Entity Address
111 EAST 210TH STREET
BRONX, NY 10467
Medicare Provider Number
330059
Participating Start Date
4/1/2005
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
MT CARMEL PHARMACY INC
Pharmacy Address
705 E 187TH ST
BRONX, NY 10458-6803
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Menashy, Vice President of Finance
(917) 280-2722
Contract Pharmacy Representative
Pharmacy
Armand Paganelli, Owner
(718) 264-6100 Ext: 308
Signed By Date
4/15/2020
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