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ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
DSH330024 THE MOUNT SINAI HOSPITAL
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Covered Entity Details
Entity Name
THE MOUNT SINAI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330024
Entity Address
ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029
Medicare Provider Number
330024
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Pharmacy Address
ICAHN SCHOOL OF MEDICINE PHARMACY
1468 MADISON AVE
ANNENBERG-MC LEVEL
NEW YORK, NY 10029
Pharmacy Comments
Contract Details
Approval Date
4/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/27/2020
Ownership change
Contacts
Covered Entity Signing Official
KENNETH DAVIS, CEO
(212) 659-8888
Contract Pharmacy Representative
Ichan School of Medicine Pharmacy
Jose Almonte, Assistant Director of Pharmacy
(212) 241-7720
Signed By Date
4/18/2016
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