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ASTORIA CHEMISTS
DSH330024A 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
DSH330024A
Entity Address
25-10 30TH AVENUE
LONG ISLAND CITY, NY 11102
Medicare Provider Number
330024
Outpatient Facility Provider Number
Participating Start Date
7/1/2006
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ASTORIA CHEMISTS
Pharmacy Address
2501 30TH AVE.
ASTORIA, NY 11102
Pharmacy Comments
02/06/2014 - Pharmacy name and address correction, changed in error on 3/28/2013, see history for details.
Contract Details
Approval Date
5/12/2011
Contract Begin Date
6/1/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
5/9/2011
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