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KINGS COUNTY MED CNTR
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
HARLEM HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330240
Entity Address
506 LENOX AVENUE
NEW YORK, NY 10037
Medicare Provider Number
330240
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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