Contract Pharmacy Details

QUEENS HOSPITAL CENTER
DSH330385 NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330385

Entity Address

3424 KOSSUTH AVE.
BRONX, NY 10467

Medicare Provider Number

330385

Participating Start Date

12/1/1992

Last Recertification Date

8/16/2021

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

QUEENS HOSPITAL CENTER

Pharmacy Address

1ST FLOOR NEW BUILDING
82-68 164TH ST
PHARMACY DEPARTMENT
JAMAICA, NY 11432-1121

Pharmacy Comments

Contract Details

Approval Date

4/15/2020

Contract Begin Date

4/17/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

New York City Health + Hospitals
Sheila Sarnoski-Brocavich, Director of Pharmacy
(718) 883-3883

Signed By Date

4/15/2020

340B Drug Pricing Program Database