340B Drug Pricing Program Database
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PALACE PHARMACY INC.
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
HARLEM HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330240
Entity Address
506 LENOX AVENUE
NEW YORK, NY 10037
Medicare Provider Number
330240
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PALACE PHARMACY INC.
Pharmacy Address
543 LENOX AVENUE
NEW YORK, NY 10037
Pharmacy Comments
Contract Details
Approval Date
10/4/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
NORMANDY 2 INC. DBA PALACE PHARMACY
HASSAN SABRA, OWNER
(212) 283-2136
Signed By Date
10/4/2017
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