Contract Pharmacy Details

DUANE READE
DSH330169 MOUNT SINAI BETH ISRAEL

Covered Entity Details

Entity Name

MOUNT SINAI BETH ISRAEL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330169

Entity Address

FIRST AVENUE AT 16TH STREET
NEW YORK, NY 10003

Medicare Provider Number

330169

Participating Start Date

7/1/2005

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

DUANE READE

Pharmacy Address

77 7TH AVENUE
NEW YORK, NY 10011

Pharmacy Comments

11/02/2012 DEA check, name update (was Walgreens #14260)

Contract Details

Approval Date

4/15/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael Bruno, Sr. Vice President
(212) 523-7140

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/15/2016

340B Drug Pricing Program Database