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27 AUDUBON PHARMACY CORP.
DSH330101V NEW YORK-PRESBYTERIAN HOSPITAL
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Covered Entity Details
Entity Name
NEW YORK-PRESBYTERIAN HOSPITAL
Subdivision Name
Project Stay
Type
Disproportionate Share Hospital
340B ID
DSH330101V
Entity Address
622 West 168th Street
VC, 4th Floor
New York, NY 10032
Medicare Provider Number
330101
Outpatient Facility Provider Number
Participating Start Date
3/22/2012
Last Recertification Date
8/30/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
27 AUDUBON PHARMACY CORP.
Pharmacy Address
D/B/A QUICK RX
27 AUDUBON AVENUE
NEW YORK, NY 10032
Pharmacy Comments
Contract Details
Approval Date
11/30/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
1/1/2018
Contract Comments
Contract Termination Date
Termination Reason
12/18/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Farrell, SVP, Finance
(212) 297-4358
Contract Pharmacy Representative
Quick Rx Pharmacy Group
Elan Katz, CEO
(917) 733-4301
Signed By Date
11/30/2017
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