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RITE AID DRUG PALACE, 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
RITE AID DRUG PALACE, INC.
Pharmacy Address
RITE AID #1845
3901 WHITE PLAINS ROAD
BRONX, NY 10466
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/13/2018
Ownership change
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/13/2016
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