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TOTAL CARE PHARMACY
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
TOTAL CARE PHARMACY
Pharmacy Address
4531 3RD AVE
BRONX, NY 10458
Pharmacy Comments
Contract Details
Approval Date
11/7/2012
Contract Begin Date
10/27/2012
Carve-In Effective Date
Contract Comments
11/07/2012 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
3/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Todd Gorlewski, CFO
(718) 960-3867
Contract Pharmacy Representative
Tony Sementilli, Owner
(718) 933-9900
Signed By Date
10/12/2012
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