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BROOKDALERX, INC.
DSH330233A BROOKDALE HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
BFCC OF BRISTOL STREET
Type
Disproportionate Share Hospital
340B ID
DSH330233A
Entity Address
1235 LINDEN BOULEVARD
BROOKLYN, NY 11212
Medicare Provider Number
330233
Outpatient Facility Provider Number
Participating Start Date
7/1/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
BROOKDALERX, INC.
Pharmacy Address
1275 LINDEN BLVD
ATTN: SUPERVISING PHARMACIST
BROOKLYN, NY 11212
Pharmacy Comments
Contract Details
Approval Date
3/31/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
7/1/2017
Contract Comments
Contacts
Covered Entity Signing Official
James Porter, CFO
(718) 240-5773
Contract Pharmacy Representative
Brookdale Hospital
Johnny Ha, Director of Pharmacy
(718) 240-5994
Signed By Date
3/31/2017
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