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MONTEFIORE MEDICAL CENTER
DSH330086 MONTEFIORE MOUNT VERNON HOSPITAL
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Covered Entity Details
Entity Name
MONTEFIORE MOUNT VERNON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330086
Entity Address
12 NORTH 7TH AVENUE
MOUNT VERNON, NY 10550
Medicare Provider Number
330086
Participating Start Date
10/1/2024
Last Recertification Date
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
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Regginald Jordan, Vice President, Executive Director
(914) 361-6100
Contract Pharmacy Representative
MONTEFIORE MEDICAL CENTER
PHILIP MANNING, DIRECTOR SPECIALTY PHARMACY
(347) 597-2576
Signed By Date
10/15/2024
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