Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH330014 JAMAICA HOSPITAL MEDICAL CENTER

Covered Entity Details

Entity Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330014

Entity Address

8900 VAN WYCK EXPRESSWAY
JAMAICA, NY 11418

Medicare Provider Number

330014

Participating Start Date

10/1/2004

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #4277
115-10 MERRICK BOULEVARD
JAMAICA, NY 11434

Pharmacy Comments

Contract Details

Approval Date

7/13/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/31/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Contract Pharmacy Representative

Rite Aid Pharmacy
Christopher Moen, VP, Strategic Pharmacy Relations
(717) 791-3129

Signed By Date

7/13/2022

340B Drug Pricing Program Database