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HMB PHARMACY MANAGEMENT LLC
DSH330059J MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
UNIVERSITY AVENUE FAMILY PRACTICE CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330059J
Entity Address
105 WEST 188TH STREET
BRONX, NY 10468
Medicare Provider Number
330059
Outpatient Facility Provider Number
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HMB PHARMACY MANAGEMENT LLC
Pharmacy Address
DBA METCARE RX#3
1 FORDHAM PLZ
BRONX, NY 10458
Pharmacy Comments
5/10/10 ADDR CHANGE (WAS 358-360 EAST 193RD STREET)
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Colleen M. Blye, Executive Vice President-CFO
(718) 920-7602
Contract Pharmacy Representative
HMB Pharmacy
RAJ SHAH, President of HMB
(732) 318-9628
Signed By Date
10/13/2017
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