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DSH330127T JACOBI MEDICAL CENTER (NYCHHC) (Active)
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Main Details
Name
JACOBI MEDICAL CENTER (NYCHHC)
Subdivision Name
NCB _ Pediatrics - Pediatrics - Pediatrics
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330127T
Medicare Provider Number
330127
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/7/2023
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
NYC Health + Hospitals
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446
Primary Contact
NYC Health + Hospitals
Mark Capuano, Senior Director, Corporate Pharmacy 340B Program
(347) 835-9198
Addresses
Street Address
3424 Kossuth Avenue
Bronx, NY 10467
Billing Address
Jacobi Medical Center (NYCHHC)
1400 Pelham Parkway
Bronx, NY 10461
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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