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DSH330059BR MONTEFIORE MEDICAL CENTER (Terminated)
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Main Details
Name
MONTEFIORE MEDICAL CENTER
Subdivision Name
Hutchinson Metro Center - Orthopaedics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330059BR
Medicare Provider Number
330059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
Last Recertification Date
9/4/2023
Termination Date
Termination Reason
1/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Montefiore Medical Center
David Menashy, Vice President of Finance
(917) 280-2722
Primary Contact
MONTEFIORE MEDICAL CENTER
PHILIP MANNING, DIRECTOR SPECIALTY PHARMACY
(347) 597-2576
Addresses
Street Address
1250 Waters Place
Orthopaedics
Bronx, NY 10461
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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