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DSH330128E ELMHURST HOSPITAL CENTER (NYCHHC) (Terminated)
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Main Details
Name
ELMHURST HOSPITAL CENTER (NYCHHC)
Subdivision Name
School Based Hospital Extension Clinic: IS 145
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330128E
Medicare Provider Number
330128
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/30/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/21/2014
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
1/1/2019
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
New York City Health and Hospitals
Paul Albertson, Vice President
(212) 748-2256
Primary Contact
New York City Health + Hospitals
Danielle Sestito, Senior Director, 340B Operations
(212) 442-3892
Addresses
Street Address
33-34 80th Street
Jackson Heights, NY 11372
Billing Address
Elmhurst Hospital
79-01 Broadway
Elmhurst, NY 11373
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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