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CONEY ISLAND HEALTH SERVICES, INC.
DSH330196 NYC Health + Hospitals/South Brooklyn Health
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Covered Entity Details
Entity Name
NYC Health + Hospitals/South Brooklyn Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330196
Entity Address
2601 OCEAN PARKWAY
BROOKLYN, NY 11235
Medicare Provider Number
330196
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CONEY ISLAND HEALTH SERVICES, INC.
Pharmacy Address
DBA SAUL'S PHARMACY & SURGICALS
3514 MERMAID AVE
BROOKLYN, NY 11224
Pharmacy Comments
Contract Details
Approval Date
4/10/2013
Contract Begin Date
4/10/2013
Carve-In Effective Date
Contract Comments
04/10/2013 - Public health emergency declared in NY effective 10/27/2012
Contract Termination Date
Termination Reason
1/21/2016
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
Coney Island Health Services, Inc.
Pervez Siddiqui, Owner
(718) 265-9108
Signed By Date
4/10/2013
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