Covered Entity Details

CAH331312-11 DELAWARE VALLEY HOSPITAL INC. (Approved) - information as of 5/23/2025 12:18:51 AM

Main Details

Name

DELAWARE VALLEY HOSPITAL INC.

Subdivision Name

UHS WALTON-CARDIOLOGY - CARDIOLOGY

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH331312-11

Medicare Provider Number

331312

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/11/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/15/2025

Last Recertification Date

Contacts

Authorizing Official

Delaware Valley Hospital, Inc.
LuCinda M Rider, Chief Financial Officer
(607) 865-2190

Primary Contact

United Health Services Hospitals, Inc
Ryan C. Decaro, Pharmacy Business Manager
(607) 763-1838

Addresses

Street Address

2 TITUS PLACE
WALTON, NY 13856

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	00347571	1417940719

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
CAH331312-01	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS PRIM CARE ROSCOE-FAMILY PRACTICE	1982 OLD RT 17	ROSCOE	NY	Active
CAH331312-02	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS PRIM CARE DOWNSVILLE-FAMILY PRACTICE	28315 State Highway 206	DOWNSVILLE	NY	Active
CAH331312-03	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS WALTON-FAMILY PRACTICE	2 TITUS PLACE	WALTON	NY	Active
CAH331312-04	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS 123 STOCKTON AVE-OUTPATIENT PHYSICAL THERAPY	123 Stockton Avenue	WALTON	NY	Active
CAH331312-05	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS 123 STOCKTON AVE-OCCUPATIONAL THERAPY - OCCUPATIONAL THERAPY	123 STOCKTON AVENUE	WALTON	NY	Approved
CAH331312-06	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS WALTON-CLINICAL NUTRITION - CLINICAL NUTRITION	2 TITUS PLACE	WALTON	NY	Approved
CAH331312-07	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS DVH-CARDIAC REHAB - CARDIAC REHAB	123 STOCKTON AVENUE	WALTON	NY	Approved
CAH331312-08	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS WALTON-DIABETES - DIABETES CARE	2 TITUS PLACE	WALTON	NY	Approved
CAH331312-09	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS WALTON-TELEHEALTH - TELEHEALTH	2 TITUS PLACE	WALTON	NY	Approved
CAH331312-10	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS WALTON-ORTHOPEDICS - ORTHOPEDICS	2 TITUS PLACE	WALTON	NY	Approved
CAH331312-11	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS WALTON-CARDIOLOGY - CARDIOLOGY	2 TITUS PLACE	WALTON	NY	Approved
CAH331312-12	Child	CAH	DELAWARE VALLEY HOSPITAL INC.	UHS WALTON-OCCUPATIONAL HEALTH - OCCUPATIONAL HEALTH	2 TITUS PLACE	WALTON	NY	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Rider, LuCinda M Chief Financial Officer Delaware Valley Hospital, Inc. 6078652190	4/15/2025 1:03 PM
Details	340B ID	Update	New Registration		CAH331312-11	4/15/2025 1:03 PM
Details	Entity Name	Update	New Registration	DELAWARE VALLEY HOSPITAL	DELAWARE VALLEY HOSPITAL INC.	4/15/2025 1:03 PM
Details	Entity Subname	Update	New Registration	UHS WALTON-CARDIOLOGY	UHS WALTON-CARDIOLOGY - CARDIOLOGY	4/15/2025 1:03 PM
Dates	Participating Approval Date	Update	New Registration		4/15/2025 1:03:24 PM	4/15/2025 1:03 PM
Details	State	Update	New Registration	Pending	Approved	4/15/2025 1:03 PM
Dates	Signed By Date	Update	New Registration		4/13/2025 5:35:00 PM	4/15/2025 1:03 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/15/2025 1:03 PM
Addresses	Main Address	Insert	New Registration		2 TITUS PLACE WALTON, NY 13856	4/11/2025 9:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2025 9:27 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00347571	4/11/2025 9:27 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/11/2025 9:27 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1417940719	4/11/2025 9:27 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	4/11/2025 9:27 AM
Contacts	Authorizing Official	Insert	New Registration		Rider, LuCinda M Chief Financial Officer Delaware Valley Hospital, Inc. 6078652190	4/11/2025 9:27 AM
Contacts	Primary Contact	Insert	New Registration		Decaro, Ryan C. Pharmacy Business Manager United Health Services Hospitals, Inc 6077631838	4/11/2025 9:27 AM
Details	Assistance Received From Date	Insert	New Registration			4/11/2025 9:27 AM
Details	Assistance Received To Date	Insert	New Registration			4/11/2025 9:27 AM
Details	Last Recertification Date	Insert	New Registration			4/11/2025 9:27 AM
Details	Grant Number	Insert	New Registration			4/11/2025 9:27 AM
Details	340B ID	Insert	New Registration			4/11/2025 9:27 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2025 9:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2025 9:27 AM
Details	Medicare Provider Number	Insert	New Registration		331312	4/11/2025 9:27 AM
Details	Entity Name	Insert	New Registration		DELAWARE VALLEY HOSPITAL	4/11/2025 9:27 AM
Details	NOFO Number	Insert	New Registration			4/11/2025 9:27 AM
Details	Program Code	Insert	New Registration		CAH	4/11/2025 9:27 AM
Details	Entity Subname	Insert	New Registration		UHS WALTON-CARDIOLOGY	4/11/2025 9:27 AM
Dates	Participating Approval Date	Insert	New Registration			4/11/2025 9:27 AM
Details	State	Insert	New Registration		Pending	4/11/2025 9:27 AM
Dates	Registration Date	Insert	New Registration		4/11/2025 9:27:19 AM	4/11/2025 9:27 AM
Dates	Signed By Date	Insert	New Registration			4/11/2025 9:27 AM
Dates	Start Date	Insert	New Registration			4/11/2025 9:27 AM
Terminations	Termination Comments	Insert	New Registration			4/11/2025 9:27 AM
Terminations	Termination Date	Insert	New Registration			4/11/2025 9:27 AM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2025 9:27 AM
Terminations	Termination Reason	Insert	New Registration			4/11/2025 9:27 AM