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DSH330221D WYCKOFF HEIGHTS MEDICAL CENTER (Terminated)
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Main Details
Name
WYCKOFF HEIGHTS MEDICAL CENTER
Subdivision Name
LAMARCA FAMILY HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330221D
Medicare Provider Number
330221
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/10/2008
Participating Start Date
1/1/2009
Participating Approval Date
12/10/2008
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Wyckoff Heights Medical Center
Ramon Rodriguez, President and CEO
(718) 963-7101
Primary Contact
Wyckoff Heights Medical Center
Joseph S Rumore, Director of Pharmacy
(718) 963-7547 Ext: 7141
Addresses
Street Address
179 JAMAICA AVE
BROOKLYN, NY 11207
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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