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2355 2ND AVE NYS LLC
DSH330204 BELLEVUE HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
BELLEVUE HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330204
Entity Address
462 FIRST AVENUE @ 27TH STREET
D/B/A NYC HEALTH & HOSPITAL CORP
NEW YORK, NY 10016
Medicare Provider Number
330204
Participating Start Date
8/1/1993
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
2355 2ND AVE NYS LLC
Pharmacy Address
2355 2ND AVE
NEW YORK, NY 10035
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446
Contract Pharmacy Representative
Branac Inc.
Elena Ivanova, COO
(212) 249-8202
Signed By Date
10/17/2022
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