Contract Pharmacy Details

GENOVESE DRUG STORES, INC.
DSH330059 MONTEFIORE MEDICAL CENTER

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

GENOVESE DRUG STORES, INC.

Pharmacy Address

RITE AID #10541
5825-35 BROADWAY
BRONX, NY 10463

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

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

4/15/2020

340B Drug Pricing Program Database