Contract Pharmacy Details

SUZMO INC.
FQHCLA334U NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Covered Entity Details

Entity Name

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Subdivision Name

East New York Diagnostic and Treatment Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA334U

Entity Address

2094 Pitkin Ave
Brooklyn, NY 11207-3509

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

SUZMO INC.

Pharmacy Address

589 SUTTER AVENUE
BROOKLYN, NY 11207

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

7/9/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

Suzmo Inc
Sujatha Dasari, President
(718) 484-8600

Signed By Date

10/12/2017

340B Drug Pricing Program Database