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BROOKDALE PHARMA INC
DSH330233 BROOKDALE HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330233
Entity Address
ONE BROOKDALE PLAZA
BROOKLYN, NY 11212
Medicare Provider Number
330233
Participating Start Date
10/1/2004
Last Recertification Date
8/28/2024
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
4/3/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
10/1/2020
Contract Comments
Contacts
Covered Entity Signing Official
James Porter, CFO
(718) 240-5773
Contract Pharmacy Representative
Sims Pharma
Nehal Patel, Supervising Pharmacist
(718) 346-7200
Signed By Date
4/3/2018
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