Contract Pharmacy Details

RITE AID OF NEW YORK, 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

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #2727
1510 SAINT NICHOLAS AVENUE
NEW YORK, NY 10033

Pharmacy Comments

Contract Details

Approval Date

4/15/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/3/2022
Pharmacy closed

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