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DRUG DEPOT CORP
DSH330009 BronxCare Health System
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Covered Entity Details
Entity Name
BronxCare Health System
Subdivision Name
Fulton Division
Type
Disproportionate Share Hospital
340B ID
DSH330009
Entity Address
1276 FULTON AVE.
BRONX, NY 10456
Medicare Provider Number
330009
Participating Start Date
7/1/1993
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
DRUG DEPOT CORP
Pharmacy Address
619 E 169TH ST
BRONX, NY 10456-2605
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VICTOR DEMARCO, CFO
(718) 901-8600
Contract Pharmacy Representative
Hispaniola Pharmaceutical Group
Reddy Bomreddy, Owner
(718) 401-7900 Ext: 7186209000
Signed By Date
10/14/2014
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