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MMC PHARMACY INC
DSH330194E MAIMONIDES MEDICAL CENTER
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Covered Entity Details
Entity Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
MAIMONIDES ADULT/PEDIATRIC DENTAL CLINIC
Type
Disproportionate Share Hospital
340B ID
DSH330194E
Entity Address
4303-4305 13TH AVENUE
BROOKLYN, NY 11219
Medicare Provider Number
330194
Outpatient Facility Provider Number
Participating Start Date
7/1/2009
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
MMC PHARMACY INC
Pharmacy Address
948 48TH ST
BROOKLYN, NY 11219-2918
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
John P Marshall, Chief Medical Officer
(718) 283-6028
Contract Pharmacy Representative
MMC Pharmacy
Neal Neumann, Director of Pharmacy and Compliance
(718) 283-8473
Signed By Date
10/9/2023
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