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HMB PHARMACY MANAGEMENT LLC
DSH330059BA MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
MMG - VIA VERDE
Type
Disproportionate Share Hospital
340B ID
DSH330059BA
Entity Address
730 BROOK AVE
BRONX, NY 10455-1333
Medicare Provider Number
330059
Outpatient Facility Provider Number
Participating Start Date
1/1/2017
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HMB PHARMACY MANAGEMENT LLC
Pharmacy Address
DBA METCARE RX#2
1515 BLONDELL AVE
BRONX, NY 10461
Pharmacy Comments
Contract Details
Approval Date
4/7/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Colleen M. Blye, Executive Vice President-CFO
(718) 920-7602
Contract Pharmacy Representative
HMB Pharmacy
RAJ SHAH, President of HMB
(732) 318-9628
Signed By Date
4/7/2017
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