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AVK RX 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
AVK RX INC
Pharmacy Address
3904 CHURCH AVE
BROOKLYN, NY 11203
Pharmacy Comments
Contract Details
Approval Date
4/26/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/4/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
AVK Rx Inc
Felix Vasserman, Main Contact
(718) 484-9810
Signed By Date
4/26/2017
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