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DSH140018F MOUNT SINAI HOSPITAL MEDICAL CENTER (Active)
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Main Details
Name
MOUNT SINAI HOSPITAL MEDICAL CENTER
Subdivision Name
Renal Dialysis
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140018F
Medicare Provider Number
140018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/22/2017
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Sinai Health System
Sameer Shah, President, Mount Sinai Hospital Medical Center
(773) 257-2012
Primary Contact
Sinai Health System
Thomas Yu, System Director of Ambulatory Pharmacy Services
(773) 257-2486
Addresses
Street Address
2642 W OGDEN AVE
CHICAGO, IL 60608-1797
Billing Address
Mount Sinai Hospital Medical Center
2750 W 15th Place
Chicago, IL 60608-1797
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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