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KINGS BRONX INC
DSH330399 ST BARNABAS HOSPITAL
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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
KINGS BRONX INC
Pharmacy Address
DBA KINGS PHARMACY
545 SAINT PAULS PL
BRONX, NY 10456-2122
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
8/5/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Todd Gorlewski, CFO
(718) 960-3867
Contract Pharmacy Representative
Shamsul Bakar, President
(718) 992-6881
Signed By Date
7/18/2012
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