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DSH330009G BronxCare Health System (Terminated)
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Main Details
Name
BronxCare Health System
Subdivision Name
BronxCare Child Study Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330009G
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
12/4/2007
Last Recertification Date
8/21/2018
Termination Date
Termination Reason
10/1/2019
Other
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
406 EAST 176TH ST.
BRONX, NY 10457
Billing Address
BronxCare Health System
1276 Fulton Avenue
Bronx, NY 10456
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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