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LINDEN PHARMA INC
DSH330233C BROOKDALE HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
Brookdale Urgent Care Center
Type
Disproportionate Share Hospital
340B ID
DSH330233C
Entity Address
1235 Linden Boulevard
Brooklyn, NY 11212
Medicare Provider Number
330233
Outpatient Facility Provider Number
Participating Start Date
10/1/2015
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
LINDEN PHARMA INC
Pharmacy Address
DBA: LINDEN PHARMACY
1368 LINDEN BLVD
BROOKLYN, NY 11212
Pharmacy Comments
Contract Details
Approval Date
3/31/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
7/1/2017
Contract Comments
Contacts
Covered Entity Signing Official
James Porter, CFO
(718) 240-5773
Contract Pharmacy Representative
Signed By Date
3/31/2017
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