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JPR PHARMACY INC
DSH330395 EPISCOPAL HEALTH SERVICES INC
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Covered Entity Details
Entity Name
EPISCOPAL HEALTH SERVICES INC
Subdivision Name
ST JOHN'S EPISCOPAL HOSPITAL - SOUTH SHORE
Type
Disproportionate Share Hospital
340B ID
DSH330395
Entity Address
327 BEACH 19TH STREET
FAR ROCKAWAY, NY 11691
Medicare Provider Number
330395
Participating Start Date
12/15/2005
Last Recertification Date
9/17/2024
Pharmacy Details
Pharmacy Name
JPR PHARMACY INC
Pharmacy Address
VISTA PHARMACY
529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691
Pharmacy Comments
Contract Details
Approval Date
2/11/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/7/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Gerard M. Walsh, CEO
(718) 869-7320
Contract Pharmacy Representative
Russell Shvartsshteyn, President
(718) 471-2500
Signed By Date
2/11/2016
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