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GENOA HEALTHCARE LLC
DSH330119 LENOX HILL HOSPITAL
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Covered Entity Details
Entity Name
LENOX HILL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330119
Entity Address
100 EAST 77TH STREET
NEW YORK, NY 10075
Medicare Provider Number
330119
Participating Start Date
1/24/2022
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
17 E GENESEE ST STE 208
AUBURN, NY 13021
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
1/24/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/7/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2022
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