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MEDPACK 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
MEDPACK LLC
Pharmacy Address
5923 STRICKLAND AVE
BROOKLYN, NY 11234
Pharmacy Comments
Contract Details
Approval Date
1/13/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick Semenza, VP and Chief Financial Officer
(718) 488-3715
Contract Pharmacy Representative
Israel Grunwald, CEO
(347) 506-1000
Signed By Date
1/13/2017
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