Covered Entity Details

DSH330096U JONES MEMORIAL HOSPITAL (Approved) - information as of 5/3/2025 11:27:24 PM

Main Details

Name

JONES MEMORIAL HOSPITAL

Subdivision Name

JMH OLEAN CLINIC/INFUSION - OLEAN WS RHEUMATOLOGY

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330096U

Medicare Provider Number

330096

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/2/2025

Last Recertification Date

Contacts

Authorizing Official

Jones Memorial Hospital
Boyd Chappell, Vice President of Finance / Chief Financial Officer
(585) 596-4002

Primary Contact

UR Medicine
Katy Lees, Director, 340B Policy and Business Strategy
(585) 703-5169 Ext: 5855964002

Addresses

Street Address

1504 W STATE ST
OLEAN, NY 14760-2040

Billing Address

Jones Memorial Hospital
191 North Main Street
Wellsville, NY 14895

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	02389137,00354403	1720030703,1508051913
PA	1007756480001	1720030703,1508051913

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
DSH330096A	Child	DSH	JONES MEMORIAL HOSPITAL	Internal Medicine Clinic	15 LODER ST	WELLSVILLE	NY	Active
DSH330096B	Child	DSH	JONES MEMORIAL HOSPITAL	Family Practice	191 N Main Street	Wellsville	NY	Active
DSH330096C	Child	DSH	JONES MEMORIAL HOSPITAL	Pediatrics	191 N Main Street	Wellsville	NY	Active
DSH330096D	Child	DSH	JONES MEMORIAL HOSPITAL	OB/GYN	191 N Main Street	Wellsville	NY	Active
DSH330096E	Child	DSH	JONES MEMORIAL HOSPITAL	Midwife	127 N MAIN ST	WELLSVILLE	NY	Terminated
DSH330096F	Child	DSH	JONES MEMORIAL HOSPITAL	Medical Practice - Belmont Office	5877 ROUTE 19	BELMONT	NY	Active
DSH330096G	Child	DSH	JONES MEMORIAL HOSPITAL	Family Practice	120 FIRST ST	BOLIVAR	NY	Active
DSH330096H	Child	DSH	JONES MEMORIAL HOSPITAL	OB/GYN	7309 Seneca Road North	HORNELL	NY	Active
DSH330096J	Child	DSH	JONES MEMORIAL HOSPITAL	Internal Medicine/Pulmonary	15 LODER ST	WELLSVILLE	NY	Active
DSH330096K	Child	DSH	JONES MEMORIAL HOSPITAL	OLEAN ONCOLOGY AND INFUSION - Oncology	1504 W State Street	Olean	NY	Active
DSH330096L	Child	DSH	JONES MEMORIAL HOSPITAL	THE MEMORIAL HOSPITAL OF WILLIAM F - Rheumatology Infusion and Clinic	7309 SENECA RD N	HORNELL	NY	Active
DSH330096M	Child	DSH	JONES MEMORIAL HOSPITAL	THE MEMORIAL HOSPITAL OF WILLIAM F - Rheumatology	1504 W STATE ST	OLEAN	NY	Active
DSH330096N	Child	DSH	JONES MEMORIAL HOSPITAL	Andover Primary Care - Andover Primary Care	13 S Main Street, Floor 1	Andover	NY	Active
DSH330096P	Child	DSH	JONES MEMORIAL HOSPITAL	HORNELL PRIMARY CARE - HRNL MV PRIMARY CARE-STE109	7309 SENECA RD N	HORNELL	NY	Active
DSH330096Q	Child	DSH	JONES MEMORIAL HOSPITAL	HORNELL PRIMARY CARE - HRNL MV PRIMARY CARE-STE101	7309 SENECA RD N	HORNELL	NY	Active
DSH330096R	Child	DSH	JONES MEMORIAL HOSPITAL	JONES MEMORIAL HOPSITAL - WLSVL 127NM PRIM CARE	127 N MAIN ST	WELLSVILLE	NY	Active
DSH330096S	Child	DSH	JONES MEMORIAL HOSPITAL	ALFRED GS PRIMARY CARE - ALFRED GS PRIMARY CARE	35 Glen Street	Alfred	NY	Active
DSH330096T	Child	DSH	JONES MEMORIAL HOSPITAL	JMH HORNELL SPECIALTY PRACTICES - HRNL MV NEUROLOGY (JMH)	7309 SENECA RD N	HORNELL	NY	Active
DSH330096U	Child	DSH	JONES MEMORIAL HOSPITAL	JMH OLEAN CLINIC/INFUSION - OLEAN WS RHEUMATOLOGY	1504 W STATE ST	OLEAN	NY	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Chappell, Boyd Vice President of Finance / Chief Financial Officer Jones Memorial Hospital 5855964002	4/2/2025 9:52 AM
Details	340B ID	Update	New Registration		DSH330096U	4/2/2025 9:52 AM
Details	Entity Subname	Update	New Registration	JMH OLEAN CLINIC/INFUSION	JMH OLEAN CLINIC/INFUSION - OLEAN WS RHEUMATOLOGY	4/2/2025 9:52 AM
Dates	Participating Approval Date	Update	New Registration		4/2/2025 9:52:25 AM	4/2/2025 9:52 AM
Details	State	Update	New Registration	Pending	Approved	4/2/2025 9:52 AM
Dates	Signed By Date	Update	New Registration		4/2/2025 9:23:02 AM	4/2/2025 9:52 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/2/2025 9:52 AM
Addresses	Main Address	Insert	New Registration		1504 W STATE ST OLEAN, NY 14760-2040	4/2/2025 9:04 AM
Addresses	Billing Address	Insert	New Registration		Jones Memorial Hospital 191 North Main Street Wellsville, NY 14895	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		02389137	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00354403	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007756480001	4/2/2025 9:04 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/2/2025 9:04 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1720030703	4/2/2025 9:04 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	4/2/2025 9:04 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1508051913	4/2/2025 9:04 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	4/2/2025 9:04 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1720030703	4/2/2025 9:04 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/2/2025 9:04 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1508051913	4/2/2025 9:04 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/2/2025 9:04 AM
Contacts	Primary Contact	Insert	New Registration		Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857035169-5855964002	4/2/2025 9:04 AM
Contacts	Authorizing Official	Insert	New Registration		Chappell, Boyd Vice President of Finance / Chief Financial Officer Jones Memorial Hospital 5855964002	4/2/2025 9:04 AM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 9:04 AM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 9:04 AM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 9:04 AM
Details	Grant Number	Insert	New Registration			4/2/2025 9:04 AM
Details	340B ID	Insert	New Registration			4/2/2025 9:04 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 9:04 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 9:04 AM
Details	Medicare Provider Number	Insert	New Registration		330096	4/2/2025 9:04 AM
Details	Entity Name	Insert	New Registration		JONES MEMORIAL HOSPITAL	4/2/2025 9:04 AM
Details	NOFO Number	Insert	New Registration			4/2/2025 9:04 AM
Details	Program Code	Insert	New Registration		DSH	4/2/2025 9:04 AM
Details	Entity Subname	Insert	New Registration		JMH OLEAN CLINIC/INFUSION	4/2/2025 9:04 AM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 9:04 AM
Details	State	Insert	New Registration		Pending	4/2/2025 9:04 AM
Dates	Registration Date	Insert	New Registration		4/2/2025 9:04:42 AM	4/2/2025 9:04 AM
Dates	Signed By Date	Insert	New Registration			4/2/2025 9:04 AM
Dates	Start Date	Insert	New Registration			4/2/2025 9:04 AM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 9:04 AM
Terminations	Termination Date	Insert	New Registration			4/2/2025 9:04 AM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 9:04 AM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 9:04 AM