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DSH330233AA BROOKDALE HOSPITAL MEDICAL CENTER (Active)
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Main Details
Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
BHMC-IMC OR - IMC OR
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330233AA
Medicare Provider Number
330233
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/28/2021
Participating Start Date
6/1/2021
Participating Approval Date
6/1/2021
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Brookdale Hospital Medical Center
Diana Sullivan, VP
(718) 240-7449
Primary Contact
Brookdale Hospital
Johnny Ha, Director of Pharmacy
(718) 240-5994
Addresses
Street Address
1545 ATLANTIC AVENUE
BROOKLYN
BROOKLYN, NY 11213
Billing Address
BROOKDALE HOSPITAL MEDICAL CENTER
ONE BROOKDALE PLAZA
BROOKLYN, NY 11212
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (4/1/2021) until terminated effective date: (4/1/2021), reinstatement effective date: (06/01/2021)
06/01/2021
April 2025
April 2025
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