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ELMHURST STAR PHARMACY INC
DSH330128 ELMHURST HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
ELMHURST HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330128
Entity Address
79-01 BROADWAY
ELMHURST, NY 11373
Medicare Provider Number
330128
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ELMHURST STAR PHARMACY INC
Pharmacy Address
DBA: CONCOURSE PHARMACY
1850 GRAND CONCOURSE
BRONX, NY 10457-1045
Pharmacy Comments
Contract Details
Approval Date
4/8/2013
Contract Begin Date
4/8/2013
Carve-In Effective Date
Contract Comments
04/09/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
10/20/2015
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
Satya Dasari, Owner
(718) 507-7200
Signed By Date
4/8/2013
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