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CH02426F BRONX LEBANON INTEGRATED SERVICE SYSTEM INC (Terminated)
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Main Details
Name
BRONX LEBANON INTEGRATED SERVICE SYSTEM INC
Subdivision Name
BRONXCARE AT TIFFANY MEDICAL AND PEDIATRIC PRACTICE
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001633
340B ID
CH02426F
Grant Number
H80CS00625
Additional Details
Current Program Status
Terminated
Registration Date
5/31/2007
Participating Start Date
7/1/2007
Participating Approval Date
6/5/2007
Last Recertification Date
2/3/2017
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
Dr. Martin Luther King, Jr. Health Center
LIONEL P. STEWART, EXECUTIVE DIRECTOR
(718) 466-6072
Primary Contact
Bronx-Lebanon Hospital Center
Lawrence Schiller, Director of Pharmacy
(718) 518-5021
Addresses
Street Address
853 Tiffany St
Bronx, NY 10459-4503
Billing Address
DR MARTIN LUTHER KING JR HEALTH CENTER
1265 FRANKLIN AVENUE
BRONX, NY 10456
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
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