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DSH330059AX MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
MORRIS EDUCATIONAL CAMPUS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AX
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/11/2015
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Montefiore Medical Center
Ruth Cassidy, Vice President and Chief Pharmacy Officer
(718) 920-7887
Primary Contact
Montefiore Medical Center
Jessica Davidow, Assistant Director
(914) 904-4468
Addresses
Street Address
1110 BOSTON RD
BRONX, NY 10456
Billing Address
MONTEFIORE MEDICAL CENTER
111 EAST 210TH STREET
BRONX, NY 10467
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/10/15 CE reinstated effective 10/1/15, was participating from 1/1/15 to 6/30/15, not participating from 7/1/15 to 9/30/15 due to voluntarily delisting site due to a delay in the implementation of split billing software
08/10/2015
CE reinstated effective 10/1/15; was participating from 1/1/15 to 6/30/15; not participating from 7/1/15 to 9/30/15 due to voluntarily delisting site due to a delay in the implementation of split billing software.
08/07/2015
June 2025
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