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DSH330059AL MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
Theodore Roosevelt High School
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AL
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/1/2012
Participating Start Date
3/22/2012
Participating Approval Date
3/22/2012
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Montefiore Medical Center
Ruth Cassidy, Vice President and Chief Pharmacy Officer
(718) 920-7887
Primary Contact
Montefiore Medical Center
Jessica Davidow, Assistant Director
(914) 904-4468
Addresses
Street Address
500 East Fordham Road
Bronx, NY 10458
Billing Address
MONTEFIORE MEDICAL CENTER
111 EAST 210TH STREET
BRONX, NY 10467
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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