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KHELLY (NY) INC
DSH330385 NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)
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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
KHELLY (NY) INC
Pharmacy Address
D/B/A GUNHILL PHARMACY
83 E GUN HILL RD
BRONX, NY 10467
Pharmacy Comments
Contract Details
Approval Date
4/10/2013
Contract Begin Date
4/10/2013
Carve-In Effective Date
Contract Comments
04/10/2013 - Public health emergency declared in NY effective 10/27/2012
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
HMB Pharmacy
RAJ SHAH, President of HMB
(732) 318-9628
Signed By Date
4/10/2013
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