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MYRTLE PHARMACY INC
CHC29018-00 NEW YORK CITY HEALTH AND HOSPITALS
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS
Subdivision Name
Cumberland Diagnostic and Treatment Center
Type
HRSA-Funded Health Center
340B ID
CHC29018-00
Entity Address
100 N Portland Ave
Brooklyn, NY 11205-2005
Grant Number
H80CS29018
Participating Start Date
4/1/2016
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
MYRTLE PHARMACY INC
Pharmacy Address
446A MYRTLE AVE
ATTN: SUPERVISING PHARMACIST
BROOKLYN, NY 11205
Pharmacy Comments
Contract Details
Approval Date
7/19/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Contract Pharmacy Representative
Myrtle Pharmacy
David Leybengrub, Owner/president
(718) 237-4444
Signed By Date
7/19/2016
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