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DSH330059AQ MONTEFIORE MEDICAL CENTER (Terminated)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
P.S. 64
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AQ
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/1/2012
Participating Start Date
3/22/2012
Participating Approval Date
3/22/2012
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Montefiore Medical Center
David Menashy, Vice President of Finance
(917) 280-2722
Primary Contact
MONTEFIORE MEDICAL CENTER
PHILIP MANNING, DIRECTOR SPECIALTY PHARMACY
(347) 597-2576
Addresses
Street Address
1425 Walton Avenue
Bronx, NY 10452
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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