Contract Pharmacy Details

COMMCARE PHARMACY-MIA, LLC
DSH100034A MOUNT SINAI MEDICAL CENTER

Covered Entity Details

Entity Name

MOUNT SINAI MEDICAL CENTER

Subdivision Name

COMPREHENSIVE CANCER CENTER

Type

Disproportionate Share Hospital

340B ID

DSH100034A

Entity Address

4306 ALTON ROAD
MIAMI BEACH, FL 33140

Medicare Provider Number

100034

Outpatient Facility Provider Number

Participating Start Date

4/1/2007

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

COMMCARE PHARMACY-MIA, LLC

Pharmacy Address

1801 CORAL WAY
SUITE 115
MIAMI, FL 33145-2784

Pharmacy Comments

Contract Details

Approval Date

10/29/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/8/2017
Pharmacy closed

Contacts

Covered Entity Signing Official

ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520

Contract Pharmacy Representative

Kendell McManamy, VP of Operations
(954) 585-7943

Signed By Date

10/29/2014