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DSH330055F NewYork-Presbyterian / Queens (Terminated)
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Main Details
Name
NewYork-Presbyterian / Queens
Subdivision Name
NYP/ Queens Medical Extension Clinic / Ambulatory Care Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330055F
Medicare Provider Number
330055
Outpatient Facility Provider Number
330055
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/3/2013
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
NY Presbyterian/Queens
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476
Primary Contact
NewYork-Presbyterian-Queens
Alexander Melchert, Director of Pharmacy
(718) 670-1545
Addresses
Street Address
182-15 Horace Harding Expressway
Fresh Meadows, NY 11365
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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