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DSH330059AV MONTEFIORE MEDICAL CENTER (Terminated)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
WAKEFIELD
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AV
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/10/2015
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
10/1/2023
Other
Contacts
Authorizing Official
Montefiore Medical Center
David Menashy, Vice President of Finance
(917) 280-2722
Primary Contact
MONTEFIORE MEDICAL CENTER
PHILIP MANNING, DIRECTOR SPECIALTY PHARMACY
(347) 597-2576
Addresses
Street Address
600E 233RD ST
BRONX, NY 10466-2604
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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CE reinstated October 1, 2015; was participating from 1/1/2015 to 6/30/2015; not participating from 7/1/2015 to 9/30/2015 due to voluntarily delisting site due to a delay in implementation of split billing software.
08/10/2015
April 2025
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