Contract Pharmacy Details

ACCREDO HEALTH GROUP, INC.
DSH330046A MOUNT SINAI WEST

Covered Entity Details

Entity Name

MOUNT SINAI WEST

Subdivision Name

ROOSEVELT HOSPITAL

Type

Disproportionate Share Hospital

340B ID

DSH330046A

Entity Address

1000 10TH AVENUE
NEW YORK, NY 10019

Medicare Provider Number

330046

Outpatient Facility Provider Number

Participating Start Date

7/1/2005

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

ACCREDO HEALTH GROUP, INC.

Pharmacy Address

2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492

Pharmacy Comments

Contract Details

Approval Date

10/16/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/8/2019
Agreement registered in error

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Accredo
Ann Campagna, PIC
(302) 395-8937

Signed By Date

10/16/2015