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BROOKDALERX, INC.
DSH330233E BROOKDALE HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
BFCC at Bristol Family Practice - Family Practice
Type
Disproportionate Share Hospital
340B ID
DSH330233E
Entity Address
1235 Linden Blvd
Brooklyn, NY 11212
Medicare Provider Number
330233
Outpatient Facility Provider Number
Participating Start Date
1/1/2018
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
BROOKDALERX, INC.
Pharmacy Address
1275 LINDEN BLVD
ATTN: SUPERVISING PHARMACIST
BROOKLYN, NY 11212
Pharmacy Comments
Contract Details
Approval Date
1/11/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Porter, CFO
(718) 240-5773
Contract Pharmacy Representative
BrookdaleRx
Jacob Adjaye, Supervising Pharmacist
(718) 240-8200
Signed By Date
1/11/2018
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