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FLATBUSH EXPRESS PHARMACY INC
DSH330202B KINGS COUNTY HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
KINGS COUNTY HOSPITAL CENTER (NYCHHC)
Subdivision Name
Opioid Treatment Program
Type
Disproportionate Share Hospital
340B ID
DSH330202B
Entity Address
591 Kingston Ave
Brooklyn, NY 11203
Medicare Provider Number
330202
Outpatient Facility Provider Number
Participating Start Date
7/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FLATBUSH EXPRESS PHARMACY INC
Pharmacy Address
862 FLATBUSH AVE
BROOKLYN, NY 11226-3102
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
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
FLATBUSH EXPRESS PHARMACY
GENE MAZEPA, POINT OF CONTACT
(718) 282-4777
Signed By Date
10/4/2017
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