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MORRISANIA DIAGNOSTIC AND TREATMENT CENT
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
MORRISANIA DIAGNOSTIC AND TREATMENT CENT
Pharmacy Address
NEW YORK CITY HEALTH AND HOSPITAL CORPOR
1225 GERARD AVE
BRONX, NY 10452
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
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
New York City Health and Hospitals
Min Than, Assistant Vice President
(212) 442-3854
Signed By Date
7/15/2021
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