Covered Entity Details

DSH310014L THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL (Approved) - information as of 6/12/2025 6:05:33 AM

Main Details

Name

THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL

Subdivision Name

COOPER UNIVERSITY HEALTH CARE MOORE - Moorestown Surgery Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310014L

Medicare Provider Number

310014

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/3/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/8/2025

Last Recertification Date

Contacts

Authorizing Official

Cooper University Hospital
Brian M Reilly, CFO
(856) 342-2443

Primary Contact

Cooper University Hospital
Tricia Anne Ligato, Director Financial Operations
(856) 382-6519

Addresses

Street Address

400 W ROUTE 38
MOORESTOWN, NJ 08057-3219

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
NJ	4136004	1568442309
PA	000-8447240005	1568442309
NY	279910	1568442309
DE	1568442309	1568442309
MD	401705600	1568442309
FL	95655400	1568442309

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
DSH310014A	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER SURGERY CENTER	900 CENTENNIAL BLVD	VOORHEES	NJ	Active
DSH310014B	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	RANCOCAS ENDOSCOPY CENTER	218C SUNSET ROAD	WILLINGBORO	NJ	Active
DSH310014C	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER DIGESTIVE HEALTH INSTITUTE	501 FELLOWSHIP ROAD	MT. LAUREL	NJ	Active
DSH310014D	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	MD Anderson Cancer Center COOPER CANCER INSTITUTE - HEMATOLOGY ONCOLOGY INFUSION SERVICES	900 CENTENNIAL BOULEVARD	VOORHEES	NJ	Active
DSH310014E	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER CANCER INSTITUTE GYNECOLOGIC ONCOLGY/INFUSION SERVICES	900 CENTENNIAL BOULEVARD	VOORHEES	NJ	Active
DSH310014F	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	MD Anderson Cancer Center COOPER CANCER INSTITUTE - HEMATOLOGY ONCOLOGY INFUSION SERVICES	1000 SALEM ROAD	WILLINGBORO	NJ	Active
DSH310014G	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	MD Anderson Cooper Cancer Center	Two Cooper Plaza	Camden	NJ	Active
DSH310014H	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	Cooper Women's Care Center	Three Cooper Plaza	Camden	NJ	Active
DSH310014J	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	Cooper Early Intervention Program	Three Cooper Plaza	Camden	NJ	Active
DSH310014K	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER UNIVERSITY HEALTH CARE MOORE - Moorestown Oncology	400 W ROUTE 38	MOORESTOWN	NJ	Active
DSH310014L	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER UNIVERSITY HEALTH CARE MOORE - Moorestown Surgery Center	400 W ROUTE 38	MOORESTOWN	NJ	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Reilly, Brian M CFO Cooper University Hospital 8563422443	4/8/2025 1:14 PM
Details	340B ID	Update	New Registration		DSH310014L	4/8/2025 1:14 PM
Details	Entity Name	Update	New Registration	COOPER UNIVERSITY HOSPITAL	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	4/8/2025 1:14 PM
Details	Entity Subname	Update	New Registration	COOPER UNIVERSITY HEALTH CARE MOORE	COOPER UNIVERSITY HEALTH CARE MOORE - Moorestown Surgery Center	4/8/2025 1:14 PM
Dates	Participating Approval Date	Update	New Registration		4/8/2025 1:14:55 PM	4/8/2025 1:14 PM
Details	State	Update	New Registration	Pending	Approved	4/8/2025 1:14 PM
Dates	Signed By Date	Update	New Registration		4/7/2025 5:10:46 PM	4/8/2025 1:14 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/8/2025 1:14 PM
Addresses	Main Address	Insert	New Registration		400 W ROUTE 38 MOORESTOWN, NJ 08057-3219	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		4136004	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NJ	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000-8447240005	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		279910	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1568442309	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		DE	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		401705600	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		95655400	4/3/2025 3:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	4/3/2025 3:01 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568442309	4/3/2025 3:01 PM
Medicaid Billing	NPI: State	Insert	New Registration		NJ	4/3/2025 3:01 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568442309	4/3/2025 3:01 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/3/2025 3:01 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568442309	4/3/2025 3:01 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	4/3/2025 3:01 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568442309	4/3/2025 3:01 PM
Medicaid Billing	NPI: State	Insert	New Registration		DE	4/3/2025 3:01 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568442309	4/3/2025 3:01 PM
Medicaid Billing	NPI: State	Insert	New Registration		MD	4/3/2025 3:01 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568442309	4/3/2025 3:01 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	4/3/2025 3:01 PM
Contacts	Authorizing Official	Insert	New Registration		Reilly, Brian M CFO Cooper University Hospital 8563422443	4/3/2025 3:01 PM
Contacts	Primary Contact	Insert	New Registration		Ligato, Tricia Anne Director Financial Operations Cooper University Hospital 8563826519	4/3/2025 3:01 PM
Details	Assistance Received From Date	Insert	New Registration			4/3/2025 3:01 PM
Details	Assistance Received To Date	Insert	New Registration			4/3/2025 3:01 PM
Details	Last Recertification Date	Insert	New Registration			4/3/2025 3:01 PM
Details	Grant Number	Insert	New Registration			4/3/2025 3:01 PM
Details	340B ID	Insert	New Registration			4/3/2025 3:01 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/3/2025 3:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/3/2025 3:01 PM
Details	Medicare Provider Number	Insert	New Registration		310014	4/3/2025 3:01 PM
Details	Entity Name	Insert	New Registration		COOPER UNIVERSITY HOSPITAL	4/3/2025 3:01 PM
Details	NOFO Number	Insert	New Registration			4/3/2025 3:01 PM
Details	Program Code	Insert	New Registration		DSH	4/3/2025 3:01 PM
Details	Entity Subname	Insert	New Registration		COOPER UNIVERSITY HEALTH CARE MOORE	4/3/2025 3:01 PM
Dates	Participating Approval Date	Insert	New Registration			4/3/2025 3:01 PM
Details	State	Insert	New Registration		Pending	4/3/2025 3:01 PM
Dates	Registration Date	Insert	New Registration		4/3/2025 3:01:23 PM	4/3/2025 3:01 PM
Dates	Signed By Date	Insert	New Registration			4/3/2025 3:01 PM
Dates	Start Date	Insert	New Registration			4/3/2025 3:01 PM
Terminations	Termination Comments	Insert	New Registration			4/3/2025 3:01 PM
Terminations	Termination Date	Insert	New Registration			4/3/2025 3:01 PM
Terminations	Termination Effective Date	Insert	New Registration			4/3/2025 3:01 PM
Terminations	Termination Reason	Insert	New Registration			4/3/2025 3:01 PM