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NORTH CENTRAL BRONX HOSPITAL
DSH330202 KINGS COUNTY HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
KINGS COUNTY HOSPITAL CENTER (NYCHHC)
Subdivision Name
MAIN
Type
Disproportionate Share Hospital
340B ID
DSH330202
Entity Address
451 CLARKSON AVE.
BROOKLYN, NY 11203
Medicare Provider Number
330202
Participating Start Date
12/1/1992
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
NORTH CENTRAL BRONX HOSPITAL
Pharmacy Address
3424 KOSSUTH AVE
ATT PHARMACY DEPT
BRONX, NY 10467
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
North Centeral Bronx Hospital
Brian Connolly, Director of Pharmacy
(718) 519-3579
Signed By Date
4/15/2020
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