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STAT RX PHARMACY, INC.
DSH330128 ELMHURST HOSPITAL CENTER (NYCHHC)
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Covered Entity Details
Entity Name
ELMHURST HOSPITAL CENTER (NYCHHC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330128
Entity Address
79-01 BROADWAY
ELMHURST, NY 11373
Medicare Provider Number
330128
Participating Start Date
12/1/1992
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
STAT RX PHARMACY, INC.
Pharmacy Address
235 EAST 167TH STREET
BRONX, NY 10456
Pharmacy Comments
Contract Details
Approval Date
1/16/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Stat Rx
Oleg Aronov, CEO
(917) 273-5243
Signed By Date
1/16/2018
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