Contract Pharmacy Details

KINGS PARK SLOPE INC
DSH330385 NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

NORTH CENTRAL BRONX HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330385

Entity Address

3424 KOSSUTH AVE.
BRONX, NY 10467

Medicare Provider Number

330385

Participating Start Date

12/1/1992

Last Recertification Date

8/16/2021

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

KINGS PARK SLOPE INC

Pharmacy Address

D/B/A KINGS SUPER PHARMACY
357 FLATBUSH AVE
BROOKLYN, NY 11238

Pharmacy Comments

Contract Details

Approval Date

4/10/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Paul Albertson, Vice President
(212) 748-2256

Contract Pharmacy Representative

Kings Rx
Dmitry Vagman, VP
(718) 230-3535

Signed By Date

4/10/2018

340B Drug Pricing Program Database