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CEDRA PHARMACY INC.
DSH330024 THE MOUNT SINAI HOSPITAL
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Covered Entity Details
Entity Name
THE MOUNT SINAI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330024
Entity Address
ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029
Medicare Provider Number
330024
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
CEDRA PHARMACY INC.
Pharmacy Address
3027 3RD AVE
BRONX, NY 10455-2647
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
10/23/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149
Contract Pharmacy Representative
Cedra Pharmacy
Mazen Karnaby, VP Managed Care
(917) 836-8886
Signed By Date
10/15/2020
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