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NYC HEALTH + HOSPITALS / SOUTH BROOKLYN
DSH330127 JACOBI MEDICAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
JACOBI MEDICAL CENTER (NYCHHC)
Subdivision Name
FORMERLY BRONX MUNICIPAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH330127
Entity Address
1400 PELHAM PKWY SOUTH
BRONX, NY 10461
Medicare Provider Number
330127
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
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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