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DSH330194N MAIMONIDES MEDICAL CENTER (Active)
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Main Details
Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
Maimonides Breast Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330194N
Medicare Provider Number
330194
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/3/2013
Participating Start Date
1/14/2013
Participating Approval Date
1/14/2013
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
745 64th Street
Brooklyn, NY 11220-4753
Billing Address
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, NY 11219
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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1/14/13 IMMEDIATE START DATE DUE TO PUBLIC HEALTH EMERGENCY IN NY
01/14/2013
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April 2025
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