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STARRETT CITY PHARMACY
DSH330233 BROOKDALE HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330233
Entity Address
ONE BROOKDALE PLAZA
BROOKLYN, NY 11212
Medicare Provider Number
330233
Participating Start Date
10/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
STARRETT CITY PHARMACY
Pharmacy Address
1110 PENNSYLVANIA AVE STE 12
BROOKLYN, NY 11207
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/2/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert A. Palermo, CFO
(718) 240-8515
Contract Pharmacy Representative
STARRETT CITY PHARMACY
Igor Vaybaum, Supervisor
(718) 257-8777
Signed By Date
7/15/2021
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