Contract Pharmacy Details

FORDHAM ROAD RX INC.
DSH330059 MONTEFIORE MEDICAL CENTER

Covered Entity Details

Entity Name

MONTEFIORE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330059

Entity Address

111 EAST 210TH STREET
BRONX, NY 10467

Medicare Provider Number

330059

Participating Start Date

4/1/2005

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

FORDHAM ROAD RX INC.

Pharmacy Address

FORDHAM ROAD PHARMACY
2 E FORDHAM RD
BRONX, NY 10468-5445

Pharmacy Comments

Contract Details

Approval Date

4/14/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David Menashy, Vice President of Finance
(917) 280-2722

Contract Pharmacy Representative

Fordham Road RX
Ravi Chenna, President
(718) 364-3333

Signed By Date

4/14/2024

340B Drug Pricing Program Database