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B & T WEST BRIGHTON PHARMACY INC
DSH330028 RICHMOND UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
RICHMOND UNIVERSITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330028
Entity Address
355 BARD AVENUE
STATEN ISLAND, NY 10310
Medicare Provider Number
330028
Participating Start Date
11/17/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
B & T WEST BRIGHTON PHARMACY INC
Pharmacy Address
DBA B & T PHARMACY
702 CASTLETON AVE
STATEN ISLAND, NY 10310
Pharmacy Comments
Contract Details
Approval Date
4/16/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Murphy, CFO
(718) 818-3295
Contract Pharmacy Representative
Tony Gorokhovsky, Owner
(718) 273-7200
Signed By Date
4/16/2015
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