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AHG OF NEW YORK, INC
DSH330195 LONG ISLAND JEWISH MEDICAL CENTER
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Covered Entity Details
Entity Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330195
Entity Address
270-05 76TH AVENUE
NEW HYDE PARK, NY 11040
Medicare Provider Number
330195
Participating Start Date
7/1/2007
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
AHG OF NEW YORK, INC
Pharmacy Address
DBA: ACCREDO
125 CLEARBROOK RD STE 122
ELMSFORD, NY 10523-1119
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Accredo
Diana Florio, 340B Managing Director
(407) 988-7044
Signed By Date
10/5/2023
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