Contract Pharmacy Details

CEDRA PHARMACY INC.
DSH330169 MOUNT SINAI BETH ISRAEL

Covered Entity Details

Entity Name

MOUNT SINAI BETH ISRAEL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330169

Entity Address

FIRST AVENUE AT 16TH STREET
NEW YORK, NY 10003

Medicare Provider Number

330169

Participating Start Date

7/1/2005

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

340B Drug Pricing Program Database