340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
NORTH SHORE UNIVERSITY HOSPITAL
DSH330195BE LONG ISLAND JEWISH MEDICAL CENTER
Print
Covered Entity Details
Entity Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Zucker Hillside/ Martin Van Buren High School Clinic - Mental Health Clinic
Type
Disproportionate Share Hospital
340B ID
DSH330195BE
Entity Address
230-17 Hillside Ave
Queens Village, NY 11427
Medicare Provider Number
330195
Outpatient Facility Provider Number
Participating Start Date
1/1/2022
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
NORTH SHORE UNIVERSITY HOSPITAL
Pharmacy Address
DBA VIVO HEALTH PHARMACY AT MANHASSET
300 COMMUNITY DRIVE
MANHASSET, NY 11030
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
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session