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CEDARS PHARMACY
DSH330233 BROOKDALE HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330233
Entity Address
ONE BROOKDALE PLAZA
BROOKLYN, NY 11212
Medicare Provider Number
330233
Participating Start Date
10/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CEDARS PHARMACY
Pharmacy Address
95-19 57TH AVE
ELMHURST, NY 11373-4616
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diana Sullivan, VP
(718) 240-7449
Contract Pharmacy Representative
Cedars Pharmacy
Bassel Moussa, POC
(718) 271-9429
Signed By Date
4/13/2022
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