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WYCKOFF SPECIALTY SCRIPT CORP.
DSH330221 WYCKOFF HEIGHTS MEDICAL CENTER
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Covered Entity Details
Entity Name
WYCKOFF HEIGHTS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330221
Entity Address
374 STOCKHOLM STREET
BROOKLYN, NY 11237
Medicare Provider Number
330221
Participating Start Date
10/4/2019
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WYCKOFF SPECIALTY SCRIPT CORP.
Pharmacy Address
THE LOBBY PHARMACY
374 STOCKHOLM ST
BROOKLYN, NY 11237
Pharmacy Comments
Contract Details
Approval Date
8/31/2023
Contract Begin Date
8/31/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ramon Rodriguez, President and CEO
(718) 963-7101
Contract Pharmacy Representative
Wyckoff Heights Medical Center
Joseph S Rumore, Director of Pharmacy
(718) 963-7547 Ext: 7141
Signed By Date
8/31/2023
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