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DSH330059AY MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
School Health Program at Columbus High School
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AY
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/10/2016
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
925 Astor Ave
Bronx, NY 10469
Billing Address
MONTEFIORE MEDICAL CENTER
111 EAST 210TH ST
BRONX, NY 10467
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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