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FAR ROCKAWAY PHARMCY CORP
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
FAR ROCKAWAY PHARMCY CORP
Pharmacy Address
2119 MOTT AVE
FAR ROCKAWAY, NY 11691-3215
Pharmacy Comments
Contract Details
Approval Date
10/6/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gerard M. Walsh, CEO
(718) 869-7320
Contract Pharmacy Representative
Peter Patel, Owner
(718) 327-2511 Ext: 71832
Signed By Date
10/6/2016
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