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DSH330194D MAIMONIDES MEDICAL CENTER (Terminated)
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Main Details
Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
FORT HAMILTON CLINIC TREATMENT PROGRAM
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330194D
Medicare Provider Number
330194
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/11/2009
Participating Start Date
7/1/2009
Participating Approval Date
6/15/2009
Last Recertification Date
9/12/2022
Termination Date
Termination Reason
10/1/2023
Other
Contacts
Authorizing Official
Maimonides Medical Center
John P Marshall, Chief Medical Officer
(718) 283-6028
Primary Contact
Maimonides Medical Center
Yevgenia Bukher, Assistant Director, Pharmacy
(718) 283-7232
Addresses
Street Address
8710 FIFTH AVENUE
BROOKLYN, NY 11209
Billing Address
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, NY 11219
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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