Contract Pharmacy Details

DUANE READE
DSH330014 JAMAICA HOSPITAL MEDICAL CENTER

Covered Entity Details

Entity Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330014

Entity Address

8900 VAN WYCK EXPRESSWAY
JAMAICA, NY 11418

Medicare Provider Number

330014

Participating Start Date

10/1/2004

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

DUANE READE

Pharmacy Address

103-09 LIBERTY AVENUE
OZONE PARK, NY 11417-1728

Pharmacy Comments

Contract Details

Approval Date

10/12/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/8/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/12/2017

340B Drug Pricing Program Database