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DSH330059N MONTEFIORE MEDICAL CENTER (Terminated)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
SCHOOL HEALTH PROGRAM M NIELSON HIGH SCHOOL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059N
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/29/2007
Participating Start Date
4/1/2005
Participating Approval Date
10/29/2007
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Montefiore Medical Center
David Menashy, Vice President of Finance
(917) 280-2722
Primary Contact
MONTEFIORE MEDICAL CENTER
PHILIP MANNING, DIRECTOR SPECIALTY PHARMACY
(347) 597-2576
Addresses
Street Address
1010 REV J A POLITE AVE
BRONX, NY 10459
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
April 2025
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