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DSH330350D UNIVERSITY HOSPITAL OF BROOKLYN (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL OF BROOKLYN
Subdivision Name
Urgent Care Center at Bay Ridge
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330350D
Medicare Provider Number
330350
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
8/26/2019
Termination Date
Termination Reason
10/1/2020
Failure to recertify
Contacts
Authorizing Official
University Hospital of Brooklyn
Richard Bayard Miller, Chief Financial OIfficer
(718) 270-4901
Primary Contact
UNIVERSITY HOSPITAL OF BROOKLYN
Hossameldin Ghanem, Pharmacy 340B Manager
(718) 270-7648
Addresses
Street Address
699 92nd Street
Brooklyn, NY 11228
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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