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CITY DRUGS NY CORP.
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
CITY DRUGS NY CORP.
Pharmacy Address
D/B/A CITY DRUGS
1551 YORK AVE
NEW YORK, NY 10028-6022
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KENNETH DAVIS, CEO
(212) 659-8888
Contract Pharmacy Representative
Julia Sarukhanova, Pharmacist-in-charge
(212) 988-4500 Ext: 117
Signed By Date
10/17/2016
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