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2355 2ND AVE NYS LLC
DSH330214 NYU Langone Hospitals
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Covered Entity Details
Entity Name
NYU Langone Hospitals
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330214
Entity Address
550 FIRST AVENUE
NEW YORK, NY 10016
Medicare Provider Number
330214
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
2355 2ND AVE NYS LLC
Pharmacy Address
2355 2ND AVE
NEW YORK, NY 10035
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel J Widawsky, Chief Financial Officer
(212) 263-3092
Contract Pharmacy Representative
Quick Rx Pharmacy Group
Elan Katz, CEO
(917) 733-4301
Signed By Date
10/14/2022
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