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LONG ISLAND JEWISH MEDICAL CENTER AT HOM
DSH330043 SOUTH SHORE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SOUTH SHORE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330043
Entity Address
301 EAST MAIN STREET
BAY SHORE, NY 11706
Medicare Provider Number
330043
Participating Start Date
4/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
LONG ISLAND JEWISH MEDICAL CENTER AT HOM
Pharmacy Address
VIVO HEALTH PHARMACY AT HOME
225 COMMUNITY DR STE 140
GREAT NECK, NY 11021-5506
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Vivo Health
Scott Jacobson, COO
(508) 254-9792
Signed By Date
1/12/2018
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