Contract Pharmacy Details

CORAM HEALTHCARE CORPORATION OF GREATER
DSH330059 MONTEFIORE MEDICAL CENTER

Covered Entity Details

Entity Name

MONTEFIORE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330059

Entity Address

111 EAST 210TH STREET
BRONX, NY 10467

Medicare Provider Number

330059

Participating Start Date

4/1/2005

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

CORAM HEALTHCARE CORPORATION OF GREATER

Pharmacy Address

DBA CORAM CVS/SPECIALTY INFUSION SERVICE
12 JUPITER LANE
ALBANY, NY 12205-6918

Pharmacy Comments

Contract Details

Approval Date

4/14/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/4/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

David Menashy, Vice President of Finance
(917) 280-2722

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/14/2022

340B Drug Pricing Program Database