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SVRH PHARMACY INC
DSH330056 THE BROOKLYN HOSPITAL CENTER
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Covered Entity Details
Entity Name
THE BROOKLYN HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330056
Entity Address
121 DEKALB AVE
BROOKLYN, NY 11201
Medicare Provider Number
330056
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
SVRH PHARMACY INC
Pharmacy Address
161 SMITH ST
BROOKLYN, NY 11201
Pharmacy Comments
Contract Details
Approval Date
7/16/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Guarracino, Senior Vice President and CFO
(718) 250-6755
Contract Pharmacy Representative
SVRH
Suryanarayana Maddula, RPh
(718) 596-1688
Signed By Date
7/16/2014
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