Contract Pharmacy Details

CUMBERLAND DIAGNOSTIC & TREATMENT CENTER
DSH330127 JACOBI MEDICAL CENTER (NYCHHC)

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

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