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1150 WEBSTER PHARMACY INC
DSH330127 JACOBI MEDICAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
JACOBI MEDICAL CENTER (NYCHHC)
Subdivision Name
FORMERLY BRONX MUNICIPAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH330127
Entity Address
1400 PELHAM PKWY SOUTH
BRONX, NY 10461
Medicare Provider Number
330127
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
1150 WEBSTER PHARMACY INC
Pharmacy Address
D/B/A 167TH STREET PHARMACY
1150 WEBSTER AVE
BRONX, NY 10456-1045
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
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
Webster
Edwin Perez, Manager
(845) 222-9151
Signed By Date
1/17/2023
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