340B Drug Pricing Program Database
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DSH330221F WYCKOFF HEIGHTS MEDICAL CENTER (Active)
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Main Details
Name
WYCKOFF HEIGHTS MEDICAL CENTER
Subdivision Name
EXTENSION CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330221F
Medicare Provider Number
330221
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2019
Participating Start Date
10/8/2019
Participating Approval Date
10/8/2019
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Wyckoff Heights Medical Center
Vali Gache, Chief Executive Officer
(718) 204-1791
Primary Contact
Wyckoff Heights Medical Center
Joseph S Rumore, Director of Pharmacy
(718) 963-7547 Ext: 7141
Addresses
Street Address
1610 DEKALB AVENUE
BROOKLYN, NY 11237
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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