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DSH330059AC MONTEFIORE MEDICAL CENTER (Active)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
MARBLE HILL FAMILY PRACTICE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059AC
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/7/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/11/2017
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
5525 BROADWAY
BRONX, NY 10463
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2005, terminated 7/1/2015. Reinstated 7/1/2017.
05/11/2017
3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS
10/29/2007
June 2025
June 2025
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