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MARBLE HILL PHARMACY CORP.
DSH330059 MONTEFIORE MEDICAL CENTER
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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
MARBLE HILL PHARMACY CORP.
Pharmacy Address
5243 BROADWAY
BRONX, NY 10463
Pharmacy Comments
Contract Details
Approval Date
4/14/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Menashy, Vice President of Finance
(917) 280-2722
Contract Pharmacy Representative
MARBLE HILL PHARMACY
VIJAY PAGHDAL, PRESIDENT
(718) 562-5200
Signed By Date
4/14/2024
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