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GOUVERNEUR DIAGNOSTIC & TREATMENT CENTER
DSH330231 QUEENS HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
QUEENS HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330231
Entity Address
82-68 164TH ST.
JAMAICA, NY 11432
Medicare Provider Number
330231
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
GOUVERNEUR DIAGNOSTIC & TREATMENT CENTER
Pharmacy Address
ATTN: PHARMACY DEPARTMENT
227 MADISON ST
NEW YORK, NY 10002
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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