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1746 PHARMACY CORP
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
1746 PHARMACY CORP
Pharmacy Address
DBA: CLARKSON PHARMACY
524 CLARKSON AVE
BROOKLYN, NY 11203-2015
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
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Arshad Tariq, COO
(718) 774-1656
Signed By Date
4/15/2013
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