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DIPNA RX INC
DSH330080 LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
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Covered Entity Details
Entity Name
LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330080
Entity Address
234 EAST 149TH ST
BRONX, NY 10451
Medicare Provider Number
330080
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
DIPNA RX INC
Pharmacy Address
FULLER DRUG STORE
2688 3RD AVE
BRONX, NY 10454-1103
Pharmacy Comments
Contract Details
Approval Date
4/8/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Dipna Rx Inc
Mayur Shaw, Owner
(718) 292-4244
Signed By Date
4/8/2022
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