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DSH330059S MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
COMMUNITY SCHOOL 214, SO BRONX HIGH SCHOOL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059S
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
701 ST ANN'S AVENUE
BRONX, NY 10455
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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