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RITE AID OF NEW YORK, INC.
DSH330202 KINGS COUNTY HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
KINGS COUNTY HOSPITAL CENTER (NYCHHC)
Subdivision Name
MAIN
Type
Disproportionate Share Hospital
340B ID
DSH330202
Entity Address
451 CLARKSON AVE.
BROOKLYN, NY 11203
Medicare Provider Number
330202
Participating Start Date
12/1/1992
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #4738
1631-43 PITKIN AVENUE
BROOKLYN, NY 11212
Pharmacy Comments
Contract Details
Approval Date
11/9/2012
Contract Begin Date
10/27/2012
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
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/27/2012
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