340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CENTERWELL PHARMACY, INC.
DSH140018 MOUNT SINAI HOSPITAL MEDICAL CENTER
Print
Covered Entity Details
Entity Name
MOUNT SINAI HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140018
Entity Address
2750 W 15TH PLACE
CHICAGO, IL 60608-1797
Medicare Provider Number
140018
Participating Start Date
10/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
CENTERWELL PHARMACY, INC.
Pharmacy Address
9843 WINDISCH RD
WEST CHESTER, OH 45069
Pharmacy Comments
Contract Details
Approval Date
7/17/2020
Contract Begin Date
8/28/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michele Mazurek, Hospital Chief Administator
(773) 257-5021
Contract Pharmacy Representative
Centerwell
Shelley Duke, Director, Specialty Pharmacy Contracting and Infusion
(502) 994-8732
Signed By Date
7/17/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session