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LORVEN PHARMACY LLC
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
LORVEN PHARMACY LLC
Pharmacy Address
942 MANHATTAN AVENUE
ATTN: SUPERVISING PHARMACIST
BROOKLYN, NY 11222
Pharmacy Comments
Contract Details
Approval Date
10/10/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
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
Srikanth Aitharaju, President
(718) 349-2255
Signed By Date
10/10/2014
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