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DSH330128P ELMHURST HOSPITAL CENTER (NYCHHC) (Active)
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Main Details
Name
ELMHURST HOSPITAL CENTER (NYCHHC)
Subdivision Name
Elmhurst Hospital: Hope Pavilion / Pacemaker
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330128P
Medicare Provider Number
330128
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/9/2015
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
NYC Health + Hospitals
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446
Primary Contact
NYC Health + Hospitals
Mark Capuano, Senior Director, Corporate Pharmacy 340B Program
(347) 835-9198
Addresses
Street Address
77-11 Broadway
Elmhurst, NY 11373
Billing Address
Elmhurst Hospital
79-01 Broadway
Elmhurst, NY 11373
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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