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DSH140018G MOUNT SINAI HOSPITAL MEDICAL CENTER (Active)
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Main Details
Name
MOUNT SINAI HOSPITAL MEDICAL CENTER
Subdivision Name
Adult OP Behavioral Health - Behavioral Health
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140018G
Medicare Provider Number
140018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/29/2020
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
2653 West Ogden Avenue
Chicago, IL 60608
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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