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2355 2ND AVE NYS LLC
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
2355 2ND AVE NYS LLC
Pharmacy Address
2355 2ND AVE
NEW YORK, NY 10035
Pharmacy Comments
Contract Details
Approval Date
10/24/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/12/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Quick Rx Pharmacy Group
Elan Katz, CEO
(917) 733-4301
Signed By Date
10/24/2016
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