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CROSSBAY CHEMISTS CORP
DSH330014 JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330014
Entity Address
8900 VAN WYCK EXPRESSWAY
JAMAICA, NY 11418
Medicare Provider Number
330014
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CROSSBAY CHEMISTS CORP
Pharmacy Address
D/B/A CROSS BAY CHEMIST
157-02 CROSSBAY BLVD
HOWARD BEACH, NY 11414-2753
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291
Contract Pharmacy Representative
jamaica
Frank Pantina, Pharmacist
(718) 659-9500
Signed By Date
7/14/2016
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