Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH330056 THE BROOKLYN HOSPITAL CENTER

Covered Entity Details

Entity Name

THE BROOKLYN HOSPITAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330056

Entity Address

121 DEKALB AVE
BROOKLYN, NY 11201

Medicare Provider Number

330056

Participating Start Date

4/1/2005

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #3855
506-528 UTICA AVENUE
BROOKLYN, NY 11203

Pharmacy Comments

Contract Details

Approval Date

3/27/2018

Contract Begin Date

3/28/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/28/2018
Ownership change

Contacts

Covered Entity Signing Official

Donald P. Minarcik, VP Revenue Enhancement
(718) 488-3775

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

3/27/2018

340B Drug Pricing Program Database