Contract Pharmacy Details

CUMBERLAND DIAGNOSTIC & TREATMENT CENTER
DSH330128 ELMHURST HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

ELMHURST HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330128

Entity Address

79-01 BROADWAY
ELMHURST, NY 11373

Medicare Provider Number

330128

Participating Start Date

12/1/1992

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

CUMBERLAND DIAGNOSTIC & TREATMENT CENTER

Pharmacy Address

NYC HEALTH & HOSPITAL CORPORATION
100 N PORTLAND AVE
PHARMACY DEPARTMENT
BROOKLYN, NY 11205

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

New York City Health and Hospitals
Christopher Russo, Director of Pharmacy
(718) 963-8000

Signed By Date

4/15/2020

340B Drug Pricing Program Database