Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

HARLEM HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330240

Entity Address

506 LENOX AVENUE
NEW YORK, NY 10037

Medicare Provider Number

330240

Participating Start Date

12/1/1992

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #7759
1033 ST NICHOLAS AVENUE
NEW YORK, NY 10032

Pharmacy Comments

Contract Details

Approval Date

11/8/2012

Contract Begin Date

10/27/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/5/2022
Pharmacy closed

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

340B Drug Pricing Program Database