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TRUE NORTH HEALTH PHARMACY, INC.
DSH330119 LENOX HILL HOSPITAL
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Covered Entity Details
Entity Name
LENOX HILL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330119
Entity Address
100 EAST 77TH STREET
NEW YORK, NY 10075
Medicare Provider Number
330119
Participating Start Date
1/24/2022
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
TRUE NORTH HEALTH PHARMACY, INC.
Pharmacy Address
DBA: VIVO HEALTH PHARMACY AT REGO PARK
95-25 QUEENS BLVD.
SUITE GFL03
REGO PARK, NY 11374
Pharmacy Comments
Contract Details
Approval Date
1/8/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Vivo Health
Scott Jacobson, COO
(508) 254-9792
Signed By Date
1/8/2025
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