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DSH330059AT MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
South Bronx Health Center (Center for Child Health and Resiliency)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AT
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/9/2014
Participating Start Date
10/1/2017
Participating Approval Date
6/11/2014
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
890 Prospect Avenue
Bronx, NY 10459-3978
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/2/17 participating 7/1/14 until terminated effective 7/1/15, reinstated effective 10/1/17
08/02/2017
June 2025
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