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RITE AID OF NEW YORK
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)
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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
Pharmacy Address
RITE AID # 4187
2712 BROADWAY
NEW YORK, NY 10025-8701
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
9/25/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Rite Aid
Ruth Lightner, Director
(717) 731-6524
Signed By Date
10/27/2012
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