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WYCKOFF 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
WYCKOFF PHARMACY INC.
Pharmacy Address
5 GRAHAM AVENUE
BROOKLYN, NY 11206-4108
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/12/2018
Ownership change
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Wyckoff Pharmacy
Mohammad N. Rana, Owner
(718) 381-6200
Signed By Date
7/14/2017
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