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KINGS COUNTY MED CNTR
DSH330196 NYC Health + Hospitals/South Brooklyn Health
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Covered Entity Details
Entity Name
NYC Health + Hospitals/South Brooklyn Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330196
Entity Address
2601 OCEAN PARKWAY
BROOKLYN, NY 11235
Medicare Provider Number
330196
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
KINGS COUNTY MED CNTR
Pharmacy Address
C/O MAIN PHARMACY
451 CLARKSON AVE
BROOKLYN, NY 11203
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
Kings County Med Cntr
Zoraya Pod, Director of Pharmacy
(718) 245-4319
Signed By Date
4/15/2020
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