Contract Pharmacy Details

PHARMACIA POPULAR INC
DSH330396 WOODHULL HOSPITAL CENTER

Covered Entity Details

Entity Name

WOODHULL HOSPITAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330396

Entity Address

760 BROADWAY
MAIN ENTRANCE: 720 FLUSHING AV
BROOKLYN, NY 11206

Medicare Provider Number

330396

Participating Start Date

12/1/1992

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

PHARMACIA POPULAR INC

Pharmacy Address

17 MARCUS GARVEY BLVD
BROOKLYN, NY 11206-5305

Pharmacy Comments

Contract Details

Approval Date

7/2/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

Pharmacia Popular
Mohammed Rashed, Owner
(718) 218-9346

Signed By Date

7/2/2014

340B Drug Pricing Program Database