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DSH100034B MOUNT SINAI MEDICAL CENTER (Active)
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Main Details
Name
MOUNT SINAI MEDICAL CENTER
Subdivision Name
COMPREHENSIVE CANCER AT AVENTURA
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100034B
Medicare Provider Number
100034
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/18/2007
Participating Start Date
4/1/2007
Participating Approval Date
1/18/2007
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Mount Sinai Medical Center
ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520
Primary Contact
Mount Sinai Medical Center
ANA CAROLINA CALDERA, DIRECTOR OF PHARMACY
(305) 674-2855
Addresses
Street Address
2845 AVENTURA BLVD
SUITE 243
AVENTURA, FL 33180
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/19/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE
07/20/2011
3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE
01/18/2007
April 2025
April 2025
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