Contract Pharmacy Details

2355 2ND AVE NYS LLC
DSH330199 METROPOLITAN HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

METROPOLITAN HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330199

Entity Address

1901 FIRST AVE.
NEW YORK, NY 10029

Medicare Provider Number

330199

Participating Start Date

7/1/1993

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

2355 2ND AVE NYS LLC

Pharmacy Address

2355 2ND AVE
NEW YORK, NY 10035

Pharmacy Comments

Contract Details

Approval Date

10/13/2016

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

10/13/2016

340B Drug Pricing Program Database