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RITE AID OF NEW YORK, INC.
DSH330236 NewYork-Presbyterian/Brooklyn Methodist
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Covered Entity Details
Entity Name
NewYork-Presbyterian/Brooklyn Methodist
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330236
Entity Address
506 SIXTH STREET
BROOKLYN, NY 11215
Medicare Provider Number
330236
Participating Start Date
10/1/2004
Last Recertification Date
9/6/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #3869
1791 UTICA AVENUE
BROOKLYN, NY 11234
Pharmacy Comments
Contract Details
Approval Date
1/9/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Breslin, Senior VP of Finance
(718) 780-3031
Contract Pharmacy Representative
Rite Aid
Chris Hall, Senior Vice President
(717) 214-8834
Signed By Date
1/9/2015
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