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HMB PHARMACY MANAGEMENT LLC
DSH330059V MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
PRIMARY CARE NETWORK (FHC)
Type
Disproportionate Share Hospital
340B ID
DSH330059V
Entity Address
1 Fordham Plaza (5th Floor)
BRONX, NY 10458
Medicare Provider Number
330059
Outpatient Facility Provider Number
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HMB PHARMACY MANAGEMENT LLC
Pharmacy Address
DBA METCARE RX#3
1 FORDHAM PLZ
BRONX, NY 10458
Pharmacy Comments
5/10/10 ADDR CHANGE (WAS 358-360 EAST 193RD STREET)
Contract Details
Approval Date
4/29/2010
Contract Begin Date
4/29/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOEL PERLMAN, CHIEF FINANCIAL OFFICER
(718) 920-7602
Contract Pharmacy Representative
ATUL SHAH, PRESIDENT / OWNER
(201) 600-1705
Signed By Date
4/22/2010
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