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DSH330059H MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
SCHOOL HEALTH PROGRAM PS 105
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059H
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
725 BRADY AVENUE
BRONX, NY 10462
Billing Address
Montefiore Medical Center
111 East 210th Street
Bronx, NY 10467
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS
10/29/2007
June 2025
June 2025
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