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MONTEFIORE MEDICAL CENTER
DSH330104 MONTEFIORE NYACK HOSPITAL
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Covered Entity Details
Entity Name
MONTEFIORE NYACK HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330104
Entity Address
160 NORTH MIDLAND AVENUE
NYACK, NY 10960
Medicare Provider Number
330104
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MONTEFIORE MEDICAL CENTER
Pharmacy Address
DBA MONTEFIORE SPECIALTY PHARMACY
100 CORPORATE BLVD STE 111
YONKERS, NY 10701
Pharmacy Comments
Contract Details
Approval Date
4/8/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John S. Burke, CFO
(845) 348-2107
Contract Pharmacy Representative
Montefiore
Steve Tuckman, Director of Community and Specialty Pharmacy Operations
(914) 377-4471
Signed By Date
4/8/2024
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