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AL KOSTO
DSH330128 ELMHURST HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
ELMHURST HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330128
Entity Address
79-01 BROADWAY
ELMHURST, NY 11373
Medicare Provider Number
330128
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
AL KOSTO
Pharmacy Address
37-65 90TH ST
JACKSON HEIGHTS, NY 11372-7829
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446
Contract Pharmacy Representative
ROOSEVELT PHARMACY CORP
ELENA LUNA, OWNER
(718) 446-2068
Signed By Date
7/14/2023
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