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VENKAT PHARM INC
DSH330397 INTERFAITH MEDICAL CENTER
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Covered Entity Details
Entity Name
INTERFAITH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330397
Entity Address
1545 ATLANTIC AVENUE
BROOKLYN, NY 11213
Medicare Provider Number
330397
Participating Start Date
7/1/2005
Last Recertification Date
9/14/2020
Entity Termination Date
6/1/2021
Pharmacy Details
Pharmacy Name
VENKAT PHARM INC
Pharmacy Address
DBA: RITE CHOICE PHARMACY
1484 FULTON ST
BROOKLYN, NY 11216-2505
Pharmacy Comments
Contract Details
Approval Date
10/5/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Charles Bove, COO
(718) 613-6465
Contract Pharmacy Representative
Venkat Rite Choice Pharmacy
Chirag Parikh, Supervising Pharmacist
(646) 662-5244
Signed By Date
10/5/2015
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