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NEW HOLLIS INC
DSH330014C JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
MEDISYS FAMILY CARE CENTER (HOLLIS)
Type
Disproportionate Share Hospital
340B ID
DSH330014C
Entity Address
188-03 Jamaica Avenue
HOLLIS, NY 11423
Medicare Provider Number
330014
Outpatient Facility Provider Number
Participating Start Date
9/1/2008
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
NEW HOLLIS INC
Pharmacy Address
D/B/A HOLLIS PHARMACY
18806A JAMAICA AVE
HOLLIS, NY 11423-2555
Pharmacy Comments
Contract Details
Approval Date
7/2/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
7/1/2016
Contract Comments
Contract Termination Date
Termination Reason
7/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291
Contract Pharmacy Representative
Gohar Iqbal, Pharmacist
(718) 776-8505
Signed By Date
7/2/2015
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