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DSH330009 BronxCare Health System (Active)
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Main Details
Name
BronxCare Health System
Subdivision Name
Fulton Division
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330009
Medicare Provider Number
330009
Additional Details
Current Program Status
Active
Registration Date
12/5/2007
Participating Start Date
7/1/1993
Participating Approval Date
12/5/2007
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Bronx Lebanon Hospital Center
VICTOR DEMARCO, CFO
(718) 901-8600
Primary Contact
BronxCare Health System
Kyoung-Sil Kang, Director of Pharmacy
(718) 518-5021
Addresses
Street Address
1276 FULTON AVE.
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; 12/5/07 DELETED ADDR2 (1309 FULTON AVE. OUTPATIENT)
07/07/2011
6/28/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE; 12/5/07 DELETED ADDR2 (1309 FULTON AVE. OUTPATIENT)
07/07/2011
April 2025
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