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FIRST HEALTH PHARMACY
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
FIRST HEALTH PHARMACY
Pharmacy Address
PGU PHARMACY INC
1229 FRANKLIN AVE
BRONX, NY 10456
Pharmacy Comments
Contract Details
Approval Date
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VICTOR DEMARCO, CFO
(718) 901-8600
Contract Pharmacy Representative
Ravi Rx
Ravi Annamaneni, Pharmacy Owner
(848) 218-3530
Signed By Date
7/11/2017
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