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MANHATTAN RX LLC
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
MANHATTAN RX LLC
Pharmacy Address
DBA BOSTON ROAD PHARMACY
3456 BOSTON RD
BRONX, NY 10469-2512
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
MANHATTAN RX DBA BOSTON ROAD PHARMACY
RAVINDER ANNAMANENI, PRESIDENT
(718) 733-4150
Signed By Date
4/14/2024
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