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PILGRIM PHARMACY INC
DSH330127 JACOBI MEDICAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
JACOBI MEDICAL CENTER (NYCHHC)
Subdivision Name
FORMERLY BRONX MUNICIPAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH330127
Entity Address
1400 PELHAM PKWY SOUTH
BRONX, NY 10461
Medicare Provider Number
330127
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PILGRIM PHARMACY INC
Pharmacy Address
2941 WESTCHESTER AVE
BRONX, NY 10461-4534
Pharmacy Comments
Contract Details
Approval Date
11/6/2012
Contract Begin Date
10/27/2012
Carve-In Effective Date
Contract Comments
11/06/2012 public health emergency declared in the state of NY effective 10/27/2012
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Pilgrim Pharmacy
Ray Macioci, Owner
(718) 823-1085
Signed By Date
9/20/2012
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