Contract Pharmacy Details

KINGS DRUGS INC
DSH330080 LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)

Covered Entity Details

Entity Name

LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330080

Entity Address

234 EAST 149TH ST
BRONX, NY 10451

Medicare Provider Number

330080

Participating Start Date

12/1/1992

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

KINGS DRUGS INC

Pharmacy Address

DBA NYS PHARMACY
306 E 149TH ST
BRONX, NY 10451

Pharmacy Comments

Contract Details

Approval Date

7/14/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

Kings Drugs Inc
Ronald Rivas, Owner
(347) 918-9337

Signed By Date

7/14/2021

340B Drug Pricing Program Database