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DSH330046L ST. LUKES ROOSEVELT HOSPITAL CENTER (Terminated)
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Main Details
Name
ST. LUKES ROOSEVELT HOSPITAL CENTER
Subdivision Name
LOUIS BRANDEIS HIGH SCHOOL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330046L
Medicare Provider Number
330046
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/10/2015
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
Mount Sinai
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149
Primary Contact
mount sinai health system
Philip Manning, Senior Director of Pharmacy
(718) 267-4295
Addresses
Street Address
145 WEST 84TH STREET
NEW YORK, NY 10019-8022
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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