340B Drug Pricing Program Database
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DSH330195G LONG ISLAND JEWISH MEDICAL CENTER (Active)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Brian Picolo MS53 Clinic SBHC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195G
Medicare Provider Number
330195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/9/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/12/2014
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058
Primary Contact
Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720
Addresses
Street Address
1045 Nameoke Street
Far Rockaway, NY 11691
Billing Address
LONG ISLAND JEWISH MEDICAL CENTER
270-05 76th Ave
New Hyde Park, NY 11040
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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