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RITE AID OF NEW YORK, INC.
DSH330196 NYC Health + Hospitals/South Brooklyn Health
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Covered Entity Details
Entity Name
NYC Health + Hospitals/South Brooklyn Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330196
Entity Address
2601 OCEAN PARKWAY
BROOKLYN, NY 11235
Medicare Provider Number
330196
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #3888
9738 SEA VIEW AVENUE
BROOKLYN, NY 11236
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/15/2021
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