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MEDILANE PHARMACY CORP
FQHCLA334AH NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
Gouverneur Healthcare Services
Type
Health Center Program Look-Alike
340B ID
FQHCLA334AH
Entity Address
227 Madison St
New York, NY 10002-7537
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
2/22/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
MEDILANE PHARMACY CORP
Pharmacy Address
204 CLINTON STREET
NEW YORK, NY 10002
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
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Medilane Pharmacy Corp
Miriam Fung, Pharmacy Manager
(212) 571-2888
Signed By Date
10/12/2017
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