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RITE AID OF NEW YORK, INC.
DSH330080 LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
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Covered Entity Details
Entity Name
LINCOLN MEDICAL & MENTAL HEALTH CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330080
Entity Address
234 EAST 149TH ST
BRONX, NY 10451
Medicare Provider Number
330080
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #7910
925 SOUNDVIEW AVENUE
BRONX, NY 10473
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/13/2018
Ownership change
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/13/2016
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