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CROSS BAY CHEMIST OF OZONE PARK CORP
DSH330014G JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
MEDISYS FAMILY CARE CENTER (OZONE PK CLOCKTOWER)
Type
Disproportionate Share Hospital
340B ID
DSH330014G
Entity Address
91-20 ATLANTIC AVENUE
OZONE PARK, NY 11416
Medicare Provider Number
330014
Outpatient Facility Provider Number
Participating Start Date
9/1/2008
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
CROSS BAY CHEMIST OF OZONE PARK CORP
Pharmacy Address
DBA: CROSS BAY CHEMIST
96-05 101ST AVE
OZONE PARK, NY 11416
Pharmacy Comments
Contract Details
Approval Date
1/5/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2015
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
jamaica
Frank Pantina, Pharmacist
(718) 659-9500
Signed By Date
1/5/2014
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