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909 COLUMBUS RX NY LLC
DSH330199 METROPOLITAN HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
METROPOLITAN HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330199
Entity Address
1901 FIRST AVE.
NEW YORK, NY 10029
Medicare Provider Number
330199
Participating Start Date
7/1/1993
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
909 COLUMBUS RX NY LLC
Pharmacy Address
D/B/A QUICKRX
909 COLUMBUS AVE
NEW YORK, NY 10025
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Branac Inc.
Elena Ivanova, COO
(212) 249-8202
Signed By Date
7/13/2020
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