Covered Entity Details

DSH330188AE Mount St. Mary's Hospital and Health Center (Active) - information as of 5/3/2025 11:29:18 PM

Main Details

Name

Mount St. Mary's Hospital and Health Center

Subdivision Name

LOCKPORT MEMORIAL HOSPITAL - ULTRASOUND

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330188AE

Medicare Provider Number

330188

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/2/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/8/2024

Last Recertification Date

Contacts

Authorizing Official

Catholic Health System
Michael Osborne, Vice President, Finance
(716) 828-2011

Primary Contact

Catholic Health System
Selena Holody, Analyst, 340B Program
(716) 270-6981

Addresses

Street Address

6001 SHIMER DR
LOCKPORT, NY 14094-6412

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	01746616	1043394745

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
DSH330188A	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - EMERGENCY	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AA	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - URGENT CARE	5875 S Transit Road	Lockport	NY	Active
DSH330188AC	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - ANESTHESIA	5875 S Transit Road	Lockport	NY	Active
DSH330188AD	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - MAIN OR/GI	5875 S Transit Road	Lockport	NY	Active
DSH330188AE	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - ULTRASOUND	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AF	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - NON-INVASIVE CARDIOLOGY PROC	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AG	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - CT SCAN	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AH	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - MED SURG	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AJ	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - Prep/ Recovery	5875 S Transit Road	Lockport	NY	Active
DSH330188B	Child	DSH	Mount St. Mary's Hospital and Health Center	NEIGHBORHOOD HEALTH CENTER	3101 NINTH STREET	NIAGARA FALLS	NY	Active
DSH330188C	Child	DSH	Mount St. Mary's Hospital and Health Center	SPECIALTY MEDICAL SERVICES	5320 Military Road, Suite 107	Lewiston	NY	Terminated
DSH330188D	Child	DSH	Mount St. Mary's Hospital and Health Center	EAR, NOSE, & THROAT SERVICES	6941 ELAINE DRIVE	NIAGARA FALLS	NY	Active
DSH330188E	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Orthopedic Services	5320 Military Road, Suite 107	Lewiston	NY	Active
DSH330188F	Child	DSH	Mount St. Mary's Hospital and Health Center	Clinic for Complete Senior Care Center	1302 Main Street	Niagara Falls	NY	Active
DSH330188G	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care	5290 Military Road	Lewiston	NY	Active
DSH330188H	Child	DSH	Mount St. Mary's Hospital and Health Center	Primary Care - Colomba	1 Colomba Drive	Niagara Falls	NY	Terminated
DSH330188J	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Surgical Services	5320 Military Road	Lewiston	NY	Active
DSH330188K	Child	DSH	Mount St. Mary's Hospital and Health Center	MOUNT ST MARY'S NEUROLOGY AND STROKE	4600 MILITARY RD	NIAGARA FALLS	NY	Active
DSH330188L	Child	DSH	Mount St. Mary's Hospital and Health Center	Cardiac Center - Cardiopulmonary	5290 Military Road	Lewiston	NY	Active
DSH330188M	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Neurology Clinic - Neurology	5290 Military Road	Lewiston	NY	Active
DSH330188N	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Infectious Disease - Infectious Disease	5290 Military Road	Lewiston	NY	Active
DSH330188P	Child	DSH	Mount St. Mary's Hospital and Health Center	Neighborhood Health Center - Pediatrics - Pediatrics	3101 Ninth Street	Niagara Falls	NY	Active
DSH330188Q	Child	DSH	Mount St. Mary's Hospital and Health Center	Neighborhood Health Center - Women's Services - Women's Services	3101 Ninth Street	Niagara Falls	NY	Active
DSH330188R	Child	DSH	Mount St. Mary's Hospital and Health Center	MSM HEALTH CENTER LOCKPORT - HEALTH CENTER	6000 BROCKTON DR	LOCKPORT	NY	Terminated
DSH330188S	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Upper - Primary Care	5290 Military Road	Lewiston	NY	Active
DSH330188T	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Endocrinology - Endocrinology	5290 Military Road	Lewiston	NY	Active
DSH330188U	Child	DSH	Mount St. Mary's Hospital and Health Center	Lockport Memorial Hospital - Multispecialty HOD - Multispecialty HOD	6001 Shimer Drive	Lockport	NY	Active
DSH330188V	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - Breast Imaging	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188W	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - EMERGENCY	5875 S Transit Road	Lockport	NY	Active
DSH330188X	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - MRI	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188Y	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - NUCLEAR MEDICINE	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188Z	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - CT SCAN	5875 S Transit Road	Lockport	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Greer, Tristan Diane 340B Program Business Manager Catholic Health System 7169232920	Holody, Selena Analyst, 340B Program Catholic Health System 7162706981	1/13/2025 3:01 PM
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Osborne, Michael Vice President, Finance Catholic Health System 7168282011	10/8/2024 12:25 PM
Details	340B ID	Update	New Registration		DSH330188AE	10/8/2024 12:25 PM
Details	Entity Name	Update	New Registration	MOUNT ST. MARYS HOSPITAL	Mount St. Mary's Hospital and Health Center	10/8/2024 12:25 PM
Details	Entity Subname	Update	New Registration	LOCKPORT MEMORIAL HOSPITAL	LOCKPORT MEMORIAL HOSPITAL - ULTRASOUND	10/8/2024 12:25 PM
Dates	Participating Approval Date	Update	New Registration		10/8/2024 12:25:39 PM	10/8/2024 12:25 PM
Details	State	Update	New Registration	Pending	Approved	10/8/2024 12:25 PM
Dates	Signed By Date	Update	New Registration		10/2/2024 11:51:21 AM	10/8/2024 12:25 PM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/8/2024 12:25 PM
Addresses	Main Address	Insert	New Registration		6001 SHIMER DR LOCKPORT, NY 14094-6412	10/2/2024 9:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/2/2024 9:24 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01746616	10/2/2024 9:24 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	10/2/2024 9:24 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1043394745	10/2/2024 9:24 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	10/2/2024 9:24 AM
Contacts	Authorizing Official	Insert	New Registration		Osborne, Michael Vice President, Finance Catholic Health System 7168282011	10/2/2024 9:24 AM
Contacts	Primary Contact	Insert	New Registration		Greer, Tristan Diane 340B Program Business Manager Catholic Health System 7169232920	10/2/2024 9:24 AM
Details	Assistance Received From Date	Insert	New Registration			10/2/2024 9:24 AM
Details	Assistance Received To Date	Insert	New Registration			10/2/2024 9:24 AM
Details	Last Recertification Date	Insert	New Registration			10/2/2024 9:24 AM
Details	Grant Number	Insert	New Registration			10/2/2024 9:24 AM
Details	340B ID	Insert	New Registration			10/2/2024 9:24 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/2/2024 9:24 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/2/2024 9:24 AM
Details	Medicare Provider Number	Insert	New Registration		330188	10/2/2024 9:24 AM
Details	Entity Name	Insert	New Registration		MOUNT ST. MARYS HOSPITAL	10/2/2024 9:24 AM
Details	NOFO Number	Insert	New Registration			10/2/2024 9:24 AM
Details	Program Code	Insert	New Registration		DSH	10/2/2024 9:24 AM
Details	Entity Subname	Insert	New Registration		LOCKPORT MEMORIAL HOSPITAL	10/2/2024 9:24 AM
Dates	Participating Approval Date	Insert	New Registration			10/2/2024 9:24 AM
Details	State	Insert	New Registration		Pending	10/2/2024 9:24 AM
Dates	Registration Date	Insert	New Registration		10/2/2024 9:24:05 AM	10/2/2024 9:24 AM
Dates	Signed By Date	Insert	New Registration			10/2/2024 9:24 AM
Dates	Start Date	Insert	New Registration			10/2/2024 9:24 AM
Terminations	Termination Comments	Insert	New Registration			10/2/2024 9:24 AM
Terminations	Termination Date	Insert	New Registration			10/2/2024 9:24 AM
Terminations	Termination Effective Date	Insert	New Registration			10/2/2024 9:24 AM
Terminations	Termination Reason	Insert	New Registration			10/2/2024 9:24 AM