340B Drug Pricing Program Database
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DSH330194E MAIMONIDES MEDICAL CENTER (Active)
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Main Details
Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
MAIMONIDES ADULT/PEDIATRIC DENTAL CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330194E
Medicare Provider Number
330194
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
6/11/2009
Participating Start Date
7/1/2009
Participating Approval Date
6/15/2009
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Maimonides Medical Center
John Marshall, EVP MedAffair/Chair MedOfficer
(718) 283-8313
Primary Contact
Maimonides Medical Center
Yevgenia Bukher, Assistant Director, Pharmacy
(718) 283-7232
Addresses
Street Address
4303-4305 13TH AVENUE
BROOKLYN, NY 11219
Billing Address
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, NY 11219
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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