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DSH330059U MONTEFIORE MEDICAL CENTER (Terminated)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
JACKSON AVENUE FAMILY RESIDENCE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059U
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
8/22/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Montefiore Medical Center
David Menashy, Vice President of Finance
(917) 280-2722
Primary Contact
Montefiore Medical Center
Frank P. Sosnowski, Unified Director of Pharmacy
(718) 920-4529
Addresses
Street Address
691 E 138TH STREET
BRONX, NY 10454
Billing Address
Same as Street Address
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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