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DUANE READE
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
DUANE READE
Pharmacy Address
279 W 125TH STREET
NEW YORK, NY 10027-4408
Pharmacy Comments
11/05/2012 DEA check, name upadte(was Walgreens #14148)
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/20/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2014
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