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BROOKDALERX, INC.
DSH330233 BROOKDALE HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330233
Entity Address
ONE BROOKDALE PLAZA
BROOKLYN, NY 11212
Medicare Provider Number
330233
Participating Start Date
10/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
BROOKDALERX, INC.
Pharmacy Address
URGENT CARE RX
1235 LINDEN BLVD
BROOKLYN, NY 11212
Pharmacy Comments
Contract Details
Approval Date
1/5/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
7/1/2017
Contract Comments
Contract Termination Date
Termination Reason
1/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Goldberg, CFO
(718) 240-5186
Contract Pharmacy Representative
Brookdale Hospital
Johnny Ha, Director of Pharmacy
(718) 240-5994
Signed By Date
1/5/2016
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