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CORAM HEALTHCARE CORPORATION OF GREATER
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
CORAM HEALTHCARE CORPORATION OF GREATER
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
48-23 55TH AVENUE
MASPETH, NY 11378
Pharmacy Comments
Contract Details
Approval Date
1/15/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
KENNETH DAVIS, CEO
(212) 659-8888
Contract Pharmacy Representative
Monica Persaud, Pharmacy Manager
(516) 396-8861
Signed By Date
1/15/2017
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