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LINCOLN PLACE PHARMACY 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
LINCOLN PLACE PHARMACY INC
Pharmacy Address
1135 EASTERN PKWY
BROOKLYN, NY 11213
Pharmacy Comments
Contract Details
Approval Date
7/17/2014
Contract Begin Date
10/1/2014
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
Lincoln Place
Arshad Tariq, Owner
(718) 756-1717
Signed By Date
7/17/2014
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