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DUANE READE
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
DUANE READE
Pharmacy Address
13602 ROOSEVELT AVENUE
FLUSHING, NY 11354
Pharmacy Comments
11/02/2012 DEA check, name update (was Walgreens #14438)
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2014
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