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HARLEM HOSPITAL CENTER
FQHCLA334L NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
IS 10 Frederick Douglas Academy
Type
Health Center Program Look-Alike
340B ID
FQHCLA334L
Entity Address
2581 7th Avenue
New York, NY 10039-2619
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
2/10/2019
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
HARLEM HOSPITAL CENTER
Pharmacy Address
c/o Outpatient Pharmacy
46 West 137th Street
New York, NY 10037
Pharmacy Comments
Contract Details
Approval Date
7/27/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
harlem hospital center
Hinnah Farooqi, Director of Pharmacy Services
(212) 939-1762
Signed By Date
7/27/2015
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