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REGIONCARE INC
DSH330043 SOUTH SHORE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SOUTH SHORE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330043
Entity Address
301 EAST MAIN STREET
BAY SHORE, NY 11706
Medicare Provider Number
330043
Participating Start Date
4/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
REGIONCARE INC
Pharmacy Address
200 COMMUNITY DR
GREAT NECK, NY 11021-5510
Pharmacy Comments
Contract Details
Approval Date
10/18/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Region Care
Diane Asquino, Assistant Vice President
(516) 414-3900
Signed By Date
10/18/2022
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