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AHG OF NEW YORK, INC
DSH330160 STATEN ISLAND UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
STATEN ISLAND UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330160
Entity Address
475 SEAVIEW AVE.
STATEN ISLAND, NY 10305
Medicare Provider Number
330160
Participating Start Date
7/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
AHG OF NEW YORK, INC
Pharmacy Address
DBA: ACCREDO
125 CLEARBROOK RD STE 122
ELMSFORD, NY 10523-1119
Pharmacy Comments
Contract Details
Approval Date
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Accredo
Diana Florio, 340B Managing Director
(407) 988-7044
Signed By Date
4/16/2024
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