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HMB PHARMACY MANAGEMENT LLC
DSH330059AI MONTEFIORE MEDICAL CENTER
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Covered Entity Details
Entity Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
MONTEFIORE MEDICAL CENTER - SOUTH B
Type
Disproportionate Share Hospital
340B ID
DSH330059AI
Entity Address
871 PROSPECT AVE
BRONX, NY 10459-3913
Medicare Provider Number
330059
Outpatient Facility Provider Number
Participating Start Date
10/1/2017
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HMB PHARMACY MANAGEMENT LLC
Pharmacy Address
DBA METCARE RX#1
305 E. 161ST
BRONX, NY 10451
Pharmacy Comments
5/10/10 ADDR CHANGE (WAS 301-305 E 161ST STREET) - 5/3/2010 - STREET ADDRESS CHANGED FROM 101 STREET TO CORRECT TYPO.
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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