Contract Pharmacy Details

KINGS PARK SLOPE INC
DSH330127 JACOBI MEDICAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

JACOBI MEDICAL CENTER (NYCHHC)

Subdivision Name

FORMERLY BRONX MUNICIPAL HOSPITAL

Type

Disproportionate Share Hospital

340B ID

DSH330127

Entity Address

1400 PELHAM PKWY SOUTH
BRONX, NY 10461

Medicare Provider Number

330127

Participating Start Date

12/1/1992

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

KINGS PARK SLOPE INC

Pharmacy Address

D/B/A KINGS SUPER PHARMACY
357 FLATBUSH AVE
BROOKLYN, NY 11238

Pharmacy Comments

Contract Details

Approval Date

6/24/2021

Contract Begin Date

6/25/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

Kings Rx
Dmitry Vagman, VP
(718) 230-3535

Signed By Date

6/24/2021

340B Drug Pricing Program Database