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HARLEM SPECIALTY DRUG CORP
DSH330080 LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
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Covered Entity Details
Entity Name
LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330080
Entity Address
234 EAST 149TH ST
BRONX, NY 10451
Medicare Provider Number
330080
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
HARLEM SPECIALTY DRUG CORP
Pharmacy Address
DBA: I & S PHARMACY
1994 3RD AVE
NEW YORK, NY 10029
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/8/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446
Contract Pharmacy Representative
I & S
Abner De Los Santos, Owner
(212) 427-7223
Signed By Date
10/17/2022
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