340B Drug Pricing Program Database
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DSH330195AW LONG ISLAND JEWISH MEDICAL CENTER (Terminated)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Forest Hills Hospital / EHS - Employee Health Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195AW
Medicare Provider Number
330195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/7/2021
Last Recertification Date
8/24/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058
Primary Contact
Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720
Addresses
Street Address
102-01 66th Road
Forest Hills, NY 11375
Billing Address
Long Island Jewish Medical Center
270-05 76th Ave
New Hyde Park, NY 11040
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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