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DSH330059A MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
COMPREHENSIVE HEALTH CARE CENTER (CHCC)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059A
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/29/2007
Participating Start Date
4/1/2005
Participating Approval Date
10/29/2007
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Montefiore Medical Center
Ruth Cassidy, Vice President and Chief Pharmacy Officer
(718) 920-7887
Primary Contact
Montefiore Medical Center
Jessica Davidow, Assistant Director
(914) 904-4468
Addresses
Street Address
305 E 161ST STREET
BRONX, NY 10451
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/10/10 ADDR CHANGE (WAS 301-305 E 161ST STREET);3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS;
05/18/2010
April 2025
April 2025
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