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DSH330046J ST. LUKES ROOSEVELT HOSPITAL CENTER (Terminated)
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Main Details
Name
ST. LUKES ROOSEVELT HOSPITAL CENTER
Subdivision Name
A. PHILIP RANDOLPH CAMPUS HIGH SCHO
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330046J
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
443 WEST 135TH STREET
NEW YORK, NY 10031-9106
Billing Address
MOUNT SINAI ROOSEVELT HOSPITAL
1000 TENTH AVE
NEW YORK, NY 10019
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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