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ST LUKE'S ROOSEVELT HOSPITAL CENTER
RWI10003 AIDS Service Center of Lower Manhattan Inc
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Covered Entity Details
Entity Name
AIDS Service Center of Lower Manhattan Inc
Subdivision Name
Type
Ryan White Part A
340B ID
RWI10003
Entity Address
64 W35th Street - 3rd Fl.
New York, NY 10001
Grant Number
H89HA00015
Participating Start Date
6/11/2013
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
ST LUKE'S ROOSEVELT HOSPITAL CENTER
Pharmacy Address
MOUNT SINAI PHARMACY - CHELSEA
275 7TH AVE FL 12
NEW YORK, NY 10001
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharen I. Duke, ED/CEO
(212) 645-0875 Ext: 304
Contract Pharmacy Representative
West Village Pharmacy
Maisoun Sioufi, Supervising Pharmacist
(212) 636-3600
Signed By Date
4/16/2018
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