Contract Pharmacy Details

RITE AIDE OF NEW YORK
DSH330385 NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330385

Entity Address

3424 KOSSUTH AVE.
BRONX, NY 10467

Medicare Provider Number

330385

Participating Start Date

12/1/1992

Last Recertification Date

8/16/2021

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

RITE AIDE OF NEW YORK

Pharmacy Address

RITE AID #2703
546-558 WEST 207TH STREET
NEW YORK, NY 10034-2611

Pharmacy Comments

Contract Details

Approval Date

11/9/2012

Contract Begin Date

10/27/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/16/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

Rite Aid
Ruth Lightner, Director
(717) 731-6524

Signed By Date

10/27/2012

340B Drug Pricing Program Database