Covered Entity Details

DSH330046V MOUNT SINAI WEST (Approved) - information as of 4/28/2025 1:42:50 AM

Main Details

Name

MOUNT SINAI WEST

Subdivision Name

Mount Sinai Morningside - Oncology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330046V

Medicare Provider Number

330046

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/3/2025

Last Recertification Date

Contacts

Authorizing Official

Mount Sinai
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149

Primary Contact

Mount Sinai Health System
Samuel Wilhelm-Ross, 340B Program Director
(646) 605-2006

Addresses

Street Address

440 W 114th St
New York, NY 10025

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	01650173,02239247,03001810,00354967	1104982917,1508001405,1417192311

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
DSH330046A	Child	DSH	MOUNT SINAI WEST	ROOSEVELT HOSPITAL	1000 10TH AVENUE	NEW YORK	NY	Active
DSH330046B	Child	DSH	MOUNT SINAI WEST	ST LUKE'S HOSPITAL	1111 AMSTERDAM AVENUE	NEW YORK	NY	Active
DSH330046C	Child	DSH	ST LUKE'S ROOSEVELT HOSPITAL CENTER	TRANSPLANT PROGRAM	2074 Frederick Douglas Boulevard	NEW YORK	NY	Terminated
DSH330046D	Child	DSH	MOUNT SINAI WEST	Ambulatory Psychiatric Center - PTSD	411 West 114th Street	New York City	NY	Active
DSH330046E	Child	DSH	MOUNT SINAI WEST	Center for Comprehensive Care West 17th Street Division	230 west 17th street	New York City	NY	Terminated
DSH330046F	Child	DSH	MOUNT SINAI WEST	Ambulatory Psychatric Center/Mental health Day Treatment	411 west 114th street	New York City	NY	Active
DSH330046G	Child	DSH	MOUNT SINAI WEST	Ambulatory Psychatric Center/Mental health Clinic	411 west 114th street	New York City	NY	Active
DSH330046H	Child	DSH	MOUNT SINAI WEST	Opioid Treatment Program (MMTP)	1000 TENTH AVENUE	NEW YORK	NY	Active
DSH330046J	Child	DSH	ST. LUKES ROOSEVELT HOSPITAL CENTER	A. PHILIP RANDOLPH CAMPUS HIGH SCHO	443 WEST 135TH STREET	NEW YORK	NY	Terminated
DSH330046K	Child	DSH	ST. LUKES ROOSEVELT HOSPITAL CENTER	MARTIN LUTHER KING JR. HIGH SCHOOL	122 AMSTERDAM AVENUE	NEW YORK	NY	Terminated
DSH330046L	Child	DSH	ST. LUKES ROOSEVELT HOSPITAL CENTER	LOUIS BRANDEIS HIGH SCHOOL	145 WEST 84TH STREET	NEW YORK	NY	Terminated
DSH330046M	Child	DSH	MOUNT SINAI WEST	CARDIOLOGY CLINIC	1111 AMSTERDAM AVENUE	NEW YORK	NY	Active
DSH330046N	Child	DSH	MOUNT SINAI WEST	ST. LUKE'S INFECTIOUS DISEASE CLINIC	1111 AMSTERDAM AVENUE	NEW YORK	NY	Active
DSH330046P	Child	DSH	MOUNT SINAI WEST	MOUNT SINAI ST. LUKE'S SURGERY CLINIC	1111 AMSTERDAM AVENUE	NEW YORK	NY	Active
DSH330046Q	Child	DSH	MOUNT SINAI WEST	ST. LUKE'S GENERAL CLINIC	158 W 124th St	New York	NY	Active
DSH330046R	Child	DSH	MOUNT SINAI WEST	MOUNT SINAI WEST INFUSION	425 W 59th Street	New York	NY	Active
DSH330046S	Child	DSH	MOUNT SINAI WEST	MOUNT SINAI Saint Luke's Outpatient Clinic	1111 Amsterdam Ave.	New York	NY	Active
DSH330046T	Child	DSH	MOUNT SINAI WEST	Mount Sinai St. Luke's - Emergency Department	1111 Amsterdam Ave	New York	NY	Active
DSH330046U	Child	DSH	MOUNT SINAI WEST	Mount Sinai Morningside - Institute for Advanced Medicine	158 W 124th St	New York	NY	Active
DSH330046V	Child	DSH	MOUNT SINAI WEST	Mount Sinai Morningside - Oncology	440 W 114th St	New York	NY	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Pastier, Michael Senior VP/CFO - The Mount Sinai Hospital Mount Sinai 2127313149	4/3/2025 9:42 AM
Details	340B ID	Update	New Registration		DSH330046V	4/3/2025 9:42 AM
Details	Entity Name	Update	New Registration	MOUNT SINAI ST. LUKES ROOSEVELT HOSP	MOUNT SINAI WEST	4/3/2025 9:42 AM
Details	Entity Subname	Update	New Registration	Mount Sinai Morningside	Mount Sinai Morningside - Oncology	4/3/2025 9:42 AM
Dates	Participating Approval Date	Update	New Registration		4/3/2025 9:42:10 AM	4/3/2025 9:42 AM
Details	State	Update	New Registration	Pending	Approved	4/3/2025 9:42 AM
Dates	Signed By Date	Update	New Registration		4/2/2025 2:25:15 PM	4/3/2025 9:42 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/3/2025 9:42 AM
Addresses	Main Address	Insert	New Registration		440 W 114th St New York, NY 10025	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01650173	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		02239247	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		03001810	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00354967	4/2/2025 2:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/2/2025 2:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104982917	4/2/2025 2:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	4/2/2025 2:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508001405	4/2/2025 2:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	4/2/2025 2:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1417192311	4/2/2025 2:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	4/2/2025 2:25 PM
Contacts	Authorizing Official	Insert	New Registration		Pastier, Michael Senior VP/CFO - The Mount Sinai Hospital Mount Sinai 2127313149	4/2/2025 2:25 PM
Contacts	Primary Contact	Insert	New Registration		Wilhelm-Ross, Samuel 340B Program Director Mount Sinai Health System 6466052006	4/2/2025 2:25 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 2:25 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 2:25 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 2:25 PM
Details	Grant Number	Insert	New Registration			4/2/2025 2:25 PM
Details	340B ID	Insert	New Registration			4/2/2025 2:25 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 2:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 2:25 PM
Details	Medicare Provider Number	Insert	New Registration		330046	4/2/2025 2:25 PM
Details	Entity Name	Insert	New Registration		MOUNT SINAI ST. LUKES ROOSEVELT HOSP	4/2/2025 2:25 PM
Details	NOFO Number	Insert	New Registration			4/2/2025 2:25 PM
Details	Program Code	Insert	New Registration		DSH	4/2/2025 2:25 PM
Details	Entity Subname	Insert	New Registration		Mount Sinai Morningside	4/2/2025 2:25 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 2:25 PM
Details	State	Insert	New Registration		Pending	4/2/2025 2:25 PM
Dates	Registration Date	Insert	New Registration		4/2/2025 2:25:14 PM	4/2/2025 2:25 PM
Dates	Signed By Date	Insert	New Registration			4/2/2025 2:25 PM
Dates	Start Date	Insert	New Registration			4/2/2025 2:25 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 2:25 PM
Terminations	Termination Date	Insert	New Registration			4/2/2025 2:25 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 2:25 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 2:25 PM