Contract Pharmacy Details

S J S PHARMACY
DSH330399 ST BARNABAS HOSPITAL

Covered Entity Details

Entity Name

ST BARNABAS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330399

Entity Address

4422 THIRD AVENUE
BRONX, NY 10457

Medicare Provider Number

330399

Participating Start Date

1/1/2005

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

S J S PHARMACY

Pharmacy Address

105-107 E. BURNSIDE AVE.
BRONX, NY 10453

Pharmacy Comments

Contract Details

Approval Date

8/1/2012

Contract Begin Date

8/1/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Todd Gorlewski, CFO
(718) 960-3867

Contract Pharmacy Representative

Patrick Daddino, Owner
(718) 933-1222

Signed By Date

7/18/2012