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DSH330350G UNIVERSITY HOSPITAL OF BROOKLYN (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL OF BROOKLYN
Subdivision Name
PS 142 Stranahan - School Based Hospital Extension Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330350G
Medicare Provider Number
330350
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/3/2019
Last Recertification Date
9/8/2021
Termination Date
Termination Reason
10/1/2022
Failure to recertify
Contacts
Authorizing Official
SUNY Downstate
Sean Patrick Smith, Senior Associate Vice President & Deputy Chief Financial Officer
(718) 826-4943
Primary Contact
UNIVERSITY HOSPITAL OF BROOKLYN
Hossameldin Ghanem, Pharmacy 340B Manager
(718) 270-7648
Addresses
Street Address
610 Henry Street
Brooklyn, NY 11231
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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