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DSH330086 MONTEFIORE MOUNT VERNON HOSPITAL (Active)
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Main Details
Name
MONTEFIORE MOUNT VERNON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330086
Medicare Provider Number
330086
Additional Details
Current Program Status
Active
Registration Date
7/11/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/23/2024
Last Recertification Date
Contacts
Authorizing Official
Montefiore Mount Vernon Hospital
Regginald Jordan, Vice President, Executive Director
(914) 361-6100
Primary Contact
Montefiore Mount Vernon
George Kiage, Pharmacy Manager
(914) 306-6369
Addresses
Street Address
12 NORTH 7TH AVENUE
MOUNT VERNON, NY 10550
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2015, terminated 10/1/2016. Reinstated 10/1/2024.
07/22/2024
8/13/15 Participated starting 1-1-2007, terminated 10-1-2014, reinstated based on new registration submitted in July 2015
08/13/2015
April 2025
April 2025
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