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HMB PHARMACY MANAGEMENT LLC
DSH330059AC MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
MARBLE HILL FAMILY PRACTICE
Type
Disproportionate Share Hospital
340B ID
DSH330059AC
Entity Address
5525 BROADWAY
BRONX, NY 10463
Medicare Provider Number
330059
Outpatient Facility Provider Number
Participating Start Date
7/1/2017
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
7/19/2017
Contract Begin Date
10/1/2017
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
7/19/2017
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