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DSH330196N CONEY ISLAND HOSPITAL (NYCHHC) (Terminated)
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Main Details
Name
CONEY ISLAND HOSPITAL (NYCHHC)
Subdivision Name
MARINERS HARBOR FAMILY HEALTH CENTER - PEDIATRICS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330196N
Medicare Provider Number
330196
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/16/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/21/2017
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
1/1/2019
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
New York City Health and Hospitals
Paul Albertson, Vice President
(212) 748-2256
Primary Contact
New York City Health + Hospitals
Danielle Sestito, Senior Director, 340B Operations
(212) 442-3892
Addresses
Street Address
2040 FOREST AVENUE
STATEN ISLAND, NY 10303
Billing Address
NEW YORK CITY HEALTH AND HOSPITALS/CONEY ISLAND
2601 Ocean Parkway
Brooklyn, NY 11235
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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