Covered Entity Details

DSH330219J ERIE COUNTY MEDICAL CENTER (Active) - information as of 4/25/2025 6:29:28 PM

Main Details

Name

ERIE COUNTY MEDICAL CENTER

Subdivision Name

ECMC- 30 N Union GEC - Gastroenterology Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330219J

Medicare Provider Number

330219

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/16/2024

Last Recertification Date

Contacts

Authorizing Official

Erie County Medical Center
Jonathan Thomas Swiatkowski, Chief Financial Officer
(716) 898-6291

Primary Contact

Erie County Medical Center
Mechelle Annette DiMaria, Pharmacy Business Coordinator
(716) 898-5520

Addresses

Street Address

30 North Union Road
Buffalo, NY 14221

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NY		1437197985,1922768621

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330219B	Child	DSH	ERIE COUNTY MEDICAL CENTER	ERIE COUNTY MEDICAL CENTER CORPORAT - Depew Chemical Dependency	5087 BROADWAY	DEPEW	NY	Terminated
DSH330219C	Child	DSH	ERIE COUNTY MEDICAL CENTER	ERIE COUNTY MEDICAL CENTER CORPORAT - Bariatric Clinic Williamsville	30N UNION RD 104	BUFFALO	NY	Active
DSH330219D	Child	DSH	ERIE COUNTY MEDICAL CENTER	ERIE COUNTY MEDICAL CENTER CORPORAT - Behavioral Health Clinic	1285 MAIN ST	BUFFALO	NY	Active
DSH330219E	Child	DSH	ERIE COUNTY MEDICAL CENTER	ERIE COUNTY MEDICAL CENTER CORPORAT - Downtown Substance Abuse Clinic	1285 MAIN ST	BUFFALO	NY	Active
DSH330219F	Child	DSH	ERIE COUNTY MEDICAL CENTER	ERIE COUNTY MEDICAL CENTER CORPORAT - Northern Erie Clinical Services	2005 Sheridan Drive	Tonawanda	NY	Active
DSH330219G	Child	DSH	ERIE COUNTY MEDICAL CENTER	Dental-BGH - Dental-BGH	100 High Street	Buffalo	NY	Terminated
DSH330219H	Child	DSH	ERIE COUNTY MEDICAL CENTER	ECMC- Dental Clinic 800 Hertel - Dental Clinic	800 Hertel Avenue	Buffalo	NY	Active
DSH330219J	Child	DSH	ERIE COUNTY MEDICAL CENTER	ECMC- 30 N Union GEC - Gastroenterology Clinic	30 North Union Road	Buffalo	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Change Request		1437197985	4/8/2025 9:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	4/8/2025 9:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1922768621	4/8/2025 9:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	4/8/2025 9:37 AM
Contacts	Primary Contact	Update	PC Change Request	Ervolina, Daryl Pharmacist Erie County Medical Center 7168983282	DiMaria, Mechelle Annette Pharmacy Business Coordinator Erie County Medical Center 7168985520	3/6/2025 5:12 PM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Swiatkowski, Jonathan Thomas Chief Financial Officer Erie County Medical Center 7168986291	8/16/2024 2:28 PM
Details	340B ID	Update	New Registration		DSH330219J	8/16/2024 2:28 PM
Details	Entity Subname	Update	New Registration	ECMC- 30 N Union GEC	ECMC- 30 N Union GEC - Gastroenterology Clinic	8/16/2024 2:28 PM
Dates	Participating Approval Date	Update	New Registration		8/16/2024 2:28:08 PM	8/16/2024 2:28 PM
Details	State	Update	New Registration	Pending	Approved	8/16/2024 2:28 PM
Dates	Signed By Date	Update	New Registration		8/6/2024 12:54:18 PM	8/16/2024 2:28 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/16/2024 2:28 PM
Addresses	Main Address	Insert	New Registration		30 North Union Road Buffalo, NY 14221	7/15/2024 1:55 PM
Contacts	Primary Contact	Insert	New Registration		Ervolina, Daryl Pharmacist Erie County Medical Center 7168983282	7/15/2024 1:55 PM
Contacts	Authorizing Official	Insert	New Registration		Swiatkowski, Jonathan Thomas Chief Financial Officer Erie County Medical Center 7168986291	7/15/2024 1:55 PM
Details	Assistance Received From Date	Insert	New Registration			7/15/2024 1:55 PM
Details	Assistance Received To Date	Insert	New Registration			7/15/2024 1:55 PM
Details	Last Recertification Date	Insert	New Registration			7/15/2024 1:55 PM
Details	Grant Number	Insert	New Registration			7/15/2024 1:55 PM
Details	340B ID	Insert	New Registration			7/15/2024 1:55 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2024 1:55 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2024 1:55 PM
Details	Medicare Provider Number	Insert	New Registration		330219	7/15/2024 1:55 PM
Details	Entity Name	Insert	New Registration		ERIE COUNTY MEDICAL CENTER	7/15/2024 1:55 PM
Details	NOFO Number	Insert	New Registration			7/15/2024 1:55 PM
Details	Program Code	Insert	New Registration		DSH	7/15/2024 1:55 PM
Details	Entity Subname	Insert	New Registration		ECMC- 30 N Union GEC	7/15/2024 1:55 PM
Dates	Participating Approval Date	Insert	New Registration			7/15/2024 1:55 PM
Details	State	Insert	New Registration		Pending	7/15/2024 1:55 PM
Dates	Registration Date	Insert	New Registration		7/15/2024 1:55:31 PM	7/15/2024 1:55 PM
Dates	Signed By Date	Insert	New Registration			7/15/2024 1:55 PM
Dates	Start Date	Insert	New Registration			7/15/2024 1:55 PM
Terminations	Termination Comments	Insert	New Registration			7/15/2024 1:55 PM
Terminations	Termination Date	Insert	New Registration			7/15/2024 1:55 PM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2024 1:55 PM
Terminations	Termination Reason	Insert	New Registration			7/15/2024 1:55 PM