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GREENTREE PHARMACY 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
GREENTREE PHARMACY INC.
Pharmacy Address
291 7TH AVE
BROOKLYN, NY 11215
Pharmacy Comments
Contract Details
Approval Date
7/22/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael P. Fagan, Senior VP of Finance
(718) 780-3031
Contract Pharmacy Representative
Leonid Nudelman, owner
(718) 768-2700
Signed By Date
7/22/2016
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