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AVS PHARMACY
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
AVS PHARMACY
Pharmacy Address
D/B/A LEROY PHARMACY
314 E 204TH ST
BRONX, NY 10467
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
4/15/2013
Carve-In Effective Date
Contract Comments
04/15/2013 - 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
AVS Pharnacy
Harunur Rashid, General Manager
(718) 882-5614
Signed By Date
4/15/2013
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