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GENOVESE DRUG STORES, INC.
DSH330259 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330259
Entity Address
1000 NORTH VILLAGE AVE
ROCKVILLE CENTRE, NY 11570
Medicare Provider Number
330259
Participating Start Date
1/1/2016
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
GENOVESE DRUG STORES, INC.
Pharmacy Address
RITE AID #10615
23 EAST PARK AVENUE
LONG BEACH, NY 11561
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Morahan, VP- Finance
(516) 705-1317
Contract Pharmacy Representative
Mercy Medical Center
John Morahan, VP- Finance
(516) 705-1317
Signed By Date
7/12/2022
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