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MMC PHARMACY INC
DSH330194G MAIMONIDES MEDICAL CENTER
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Covered Entity Details
Entity Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
9TH AVENUE WOMEN'S PRIMARY CARE CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330194G
Entity Address
4422 9TH AVENUE
BROOKLYN, NY 11220
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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