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NYC HEALTH + HOSPITALS / SOUTH BROOKLYN
DSH330231 QUEENS HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
QUEENS HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330231
Entity Address
82-68 164TH ST.
JAMAICA, NY 11432
Medicare Provider Number
330231
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
NYC HEALTH + HOSPITALS / SOUTH BROOKLYN
Pharmacy Address
CONEY ISLAND HOSPITAL
2601 OCEAN PKWY
PHARMACY DEPARTMENT
BROOKLYN, NY 11235
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
4/17/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
NYCH+H Coney Island Hospital
Michael Inzerillo, Director of Pharmacy
(718) 616-4083
Signed By Date
4/15/2020
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