340B Drug Pricing Program Database

Pharmacy Name

LONG ISLAND JEWISH MEDICAL CENTER

Pharmacy Address

D/B/A VIVO HEALTH PHARMACY AT CFAM
270-05 76TH AVE
NEW HYDE PARK, NY 11040

Pharmacy Comments

Approval Date

1/9/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/10/2015
Ownership change

Covered Entity Signing Official

ROBERT S. SHAPIRO, SR. VP & CFO
(516) 465-8162

Contract Pharmacy Representative

Dirk Ramrattan, Assistant Director of Pharmacy
(516) 719-5799

Signed By Date

1/9/2015