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DSH330009J BRONX-LEBANON HOSPITAL CENTER (Terminated)
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Main Details
Name
BRONX-LEBANON HOSPITAL CENTER
Subdivision Name
ASSERTIVE COMMUNITY TREATMENT (ACT)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330009J
Medicare Provider Number
330009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/27/2007
Participating Start Date
1/1/2008
Participating Approval Date
12/5/2007
Last Recertification Date
8/17/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Bronx Lebanon Hospital Center
VICTOR DEMARCO, CFO
(718) 901-8600
Primary Contact
Bronx-Lebanon Hospital Center
Lawrence Schiller, Director of Pharmacy
(718) 518-5021
Addresses
Street Address
1276 FULTON AVE.
4TH FLOOR
BRONX, NY 10456
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/28/2011 - DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE
07/07/2011
6/28/2011 - DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE
07/07/2011
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