340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
BROOKDALERX, INC.
DSH330233B BROOKDALE HOSPITAL MEDICAL CENTER
Print
Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
Brookdale Family Care Center - Pennsylvania Ave Clinic
Type
Disproportionate Share Hospital
340B ID
DSH330233B
Entity Address
1110 Pennsylvania Avenue
Brooklyn, NY 11212
Medicare Provider Number
330233
Outpatient Facility Provider Number
Participating Start Date
4/1/2014
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
BROOKDALERX, INC.
Pharmacy Address
URGENT CARE RX
1235 LINDEN BLVD
BROOKLYN, NY 11212
Pharmacy Comments
Contract Details
Approval Date
12/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
7/1/2017
Contract Comments
Contacts
Covered Entity Signing Official
James Porter, CFO
(718) 240-5773
Contract Pharmacy Representative
Brookdale Hospital
Johnny Ha, Director of Pharmacy
(718) 240-5994
Signed By Date
12/13/2016
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session