340B Drug Pricing Program Database
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DSH330195K LONG ISLAND JEWISH MEDICAL CENTER (Terminated)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Long Island Jewish Eye Care Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195K
Medicare Provider Number
330195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/24/2021
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058
Primary Contact
Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720
Addresses
Street Address
600 Northern Blvd
Suite 214
Great Neck, NY 11021
Billing Address
LONG ISLAND JEWISH MEDICAL CENTER
270-05 76th Ave
New Hyde Park, NY 11040
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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