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NANTICOKE PHARMACY, LLC
DSH080006 NANTICOKE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NANTICOKE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH080006
Entity Address
801 MIDDLEFORD ROAD
SEAFORD, DE 19973
Medicare Provider Number
080006
Participating Start Date
1/1/2009
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
NANTICOKE PHARMACY, LLC
Pharmacy Address
1609A MIDDLEFORD RD
SEAFORD, DE 19973
Pharmacy Comments
Contract Details
Approval Date
4/1/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/27/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Ferber, Chief Clinical Innovations Officer
(302) 629-6611 Ext: 3915
Contract Pharmacy Representative
Nanticoke Pharmacy
Bimal C. Das, Owner/Pharmacist
(302) 536-7464
Signed By Date
4/1/2016
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