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NUEVA VIDA 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
NUEVA VIDA PHARMACY INC.
Pharmacy Address
81-25 37TH AVE
JACKSON HEIGHTS, NY 11372
Pharmacy Comments
Contract Details
Approval Date
1/6/2017
Contract Begin Date
4/1/2017
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
Ting Lee, Owner
(718) 426-2525
Signed By Date
1/6/2017
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