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BROOKDALE PHARMA INC
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
BROOKDALE PHARMA INC
Pharmacy Address
D/B/A BROOKDALE PHARMACY
2568 LINDEN BLVD
BROOKLYN, NY 11208-4904
Pharmacy Comments
Contract Details
Approval Date
1/8/2018
Contract Begin Date
4/1/2018
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
Brookdale Pharma Inc
Kalpeh Patel, Owner
(718) 485-0070
Signed By Date
1/8/2018
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