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DSH330059AJ MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
MONTEFIORE ONCOLOGY/PHARM/EAST
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AJ
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/29/2007
Participating Start Date
10/1/2006
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
1695 EASTCHESTER ROAD
BRONX, NY 10461
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/30/2013 Site is not a pharmacy and was terminated in error.
09/30/2013
9/3/13 Site listed as a pharmacy, per OPA guidance site was not removed or updated to an approved non-pharmacy clinical site prior to recertification. This site has been terminated JH 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS
09/03/2013
3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS
10/29/2007
June 2025
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