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WOODHULL MEDICAL & MNTL HLTH
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
WOODHULL MEDICAL & MNTL HLTH
Pharmacy Address
C/O PHARMACY
760 BROADWAY RM 1B-260
BROOKLYN, NY 11206
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
Woodhull Medical &MNTL HLTH
Ujwala Shah, Director of Pharmacy
(718) 963-8154
Signed By Date
4/15/2020
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