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TRUE NORTH HEALTH PHARMACY, INC
DSH330043F SOUTH SHORE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SOUTH SHORE UNIVERSITY HOSPITAL
Subdivision Name
Pre-Surgical Testing - Pre-Surgical Testing
Type
Disproportionate Share Hospital
340B ID
DSH330043F
Entity Address
2048 Sunrise Highway
Bay Shore, NY 11706
Medicare Provider Number
330043
Outpatient Facility Provider Number
Participating Start Date
4/1/2023
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
TRUE NORTH HEALTH PHARMACY, INC
Pharmacy Address
DBA: VIVO HEALTH PHARMACY AT CFAM
450 LAKEVILLE RD
LAKE SUCCESS, NY 11042
Pharmacy Comments
Contract Details
Approval Date
11/20/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Vivo Health
Scott Jacobson, COO
(508) 254-9792
Signed By Date
11/20/2023
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