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HEALTHY CORNER 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
HEALTHY CORNER PHARMACY INC
Pharmacy Address
116-65 QUEENS BLVD
ATTN: SUPERVISING PHARMACIST
FOREST HILLS, NY 11375
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
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
Edward Arabov, President/Owner/Pharmacist
(718) 261-6699
Signed By Date
4/15/2013
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