340B Drug Pricing Program Database
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LIVE GOOD 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
LIVE GOOD PHARMACY INC.
Pharmacy Address
1025 NOSTRAND AVE
BROOKLYN, NY 11225-1122
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/17/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
LG Drugs Inc
Ngozi Agbasionwe, Owner
(718) 484-7166
Signed By Date
4/17/2017
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