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KMN PHARMACY CORP
DSH330059 MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330059
Entity Address
111 EAST 210TH STREET
BRONX, NY 10467
Medicare Provider Number
330059
Participating Start Date
4/1/2005
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
KMN PHARMACY CORP
Pharmacy Address
D/B/A OVAL PHARMACY
255 E GUN HILL RD
BRONX, NY 10467-2109
Pharmacy Comments
Contract Details
Approval Date
5/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Menashy, Vice President of Finance
(917) 280-2722
Contract Pharmacy Representative
Oval Pharmacy
Ajay Desai, Director
(718) 654-2200
Signed By Date
5/14/2023
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