Covered Entity Details

DSH330028A RICHMOND UNIVERSITY MEDICAL CENTER (Terminated) - information as of 5/11/2025 11:32:59 PM

Main Details

Name

RICHMOND UNIVERSITY MEDICAL CENTER

Subdivision Name

BAYLEY SETON

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330028A

Medicare Provider Number

330028

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

11/16/2005

Participating Start Date

11/17/2005

Participating Approval Date

11/17/2005

Last Recertification Date

8/15/2016

Termination Date
Termination Reason

1/1/2018
Site closure

Contacts

Authorizing Official

Richmond University Medical Center
Joseph Saporito, CFO
(718) 818-3295

Primary Contact

Richmond University Medical Center
Angela Gilbride, Director of Pharmacy
(718) 818-2077

Addresses

Street Address

75 VANDERBILT AVENUE
STATEN ISLAND, NY 10304

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
3/9/07 - NAME CHANGE FROM SISTERS OF CHARITY DBA BAYLEY SETON HOSPITAL	05/17/2007

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	00248820
		1740389154

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
DSH330028A	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	BAYLEY SETON	75 VANDERBILT AVENUE	STATEN ISLAND	NY	Terminated
DSH330028AA	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Hematology / Oncology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AB	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adolescent Medical Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AC	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Medical Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AD	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Pulmonary Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AE	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Vascular Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AF	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Endocrine Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AG	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC ID Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AH	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Nephrology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AJ	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Neurology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AK	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric GI Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AL	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Renal Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028D	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	Silberstein SubstanceTREATMENT EXT. CLINIC	1130 South Avenue	STATEN ISLAND	NY	Active
DSH330028F	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	DAY TREATMENT PROGRAM (SI-CDT)	1130 South Ave.	STATEN ISLAND	NY	Active
DSH330028G	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	St. GEORGE TREATMENT PROGRAM	1130 South Ave	STATEN ISLAND	NY	Active
DSH330028H	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	St. GEORGE -MICA	1130 South Ave	STATEN ISLAND	NY	Active
DSH330028I	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	COMMUNITY TREATMENT Center	1130 South Ave	STATEN ISLAND	NY	Active
DSH330028J	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	Outpatient Cancer Center - Outpatient Cancer Treatment Services	355 Bard Avenue	Staten Island	NY	Active
DSH330028K	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Newborn Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028L	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Surgery Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028M	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Thoracic Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Terminated
DSH330028N	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Influenza Vaccine Administration	800 CASTLETON AVE	STATEN ISLAND	NY	Terminated
DSH330028P	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Hematology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028Q	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Pulmonary Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028R	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Cardiology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028S	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Gastroenterology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028T	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Neurological Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028U	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Clinic Ref	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028V	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Orthopedic Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028W	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Continuing Care Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028X	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Endo Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028Y	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Surgery Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028Z	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Urology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/6/2017 12:00:00 AM	10/19/2017 3:15 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/19/2017 3:15 PM
Terminations	Termination Date	Update	Termination Request		1/1/2018 12:00:00 AM	10/19/2017 3:15 PM
Terminations	Termination Effective Date	Update	Termination Request		10/6/2017 12:00:00 AM	10/19/2017 3:15 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	10/19/2017 3:15 PM
Contacts	Authorizing Official	Update		Saporito, Joseph CFO 7188183295	Saporito, Joseph CFO Richmond University Medical Center 7188183295	10/19/2017 10:04 AM
Contacts	Primary Contact	Update		Gilbride, Angela Director of Pharmacy 7188182077	Gilbride, Angela Director of Pharmacy Richmond University Medical Center 7188182077	10/18/2017 4:07 PM
Contacts	Authorizing Official	Update		Murphy, Kevin CFO 7188183295	Saporito, Joseph CFO 7188183295	4/6/2017 4:35 PM
Contacts	Primary Contact	Insert			Gilbride, Angela Director of Pharmacy 7188182077	12/12/2016 7:13 AM
Addresses	Main Address	Insert			75 VANDERBILT AVENUE STATEN ISLAND, NY 10304	8/16/2016 2:33 PM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/16/2016 2:33 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/31/2015 1:24 PM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/31/2015 12:00:00 AM	8/31/2015 1:24 PM
Details	Last Recertification Date	Update		9/5/2013 6:02:52 AM	9/5/2014 12:00:00 AM	9/5/2014 11:36 AM
Contacts	Authorizing Official	Insert			Murphy, Kevin CFO 7188183295	12/17/2013 10:13 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 6:02:52 AM	9/5/2013 6:02 AM
Medicaid Billing	NPI: Number	Insert			1740389154	5/29/2012 2:32 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/29/2012 2:32 PM
Details	Last Recertification Date	Insert				5/17/2007 2:39 PM
Details	Grant Number	Insert				5/17/2007 2:39 PM
Details	340B ID	Insert			DSH330028A	5/17/2007 2:39 PM
Details	Is Authorizing Official EHB Data	Insert				5/17/2007 2:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/17/2007 2:39 PM
Details	Medicare Provider Number	Insert			330028	5/17/2007 2:39 PM
Details	Entity Name	Insert			RICHMOND UNIVERSITY MEDICAL CENTER	5/17/2007 2:39 PM
Details	Program Code	Insert			DSH	5/17/2007 2:39 PM
Details	Entity Subname	Insert			BAYLEY SETON	5/17/2007 2:39 PM
Dates	Participating Approval Date	Insert			11/17/2005 12:00:00 AM	5/17/2007 2:39 PM
Details	State	Insert			Active	5/17/2007 2:39 PM
Dates	Registration Date	Insert			11/16/2005 12:00:00 AM	5/17/2007 2:39 PM
Dates	Signed By Date	Insert			11/17/2005 12:00:00 AM	5/17/2007 2:39 PM
Dates	Start Date	Insert			11/17/2005 12:00:00 AM	5/17/2007 2:39 PM
Terminations	Termination Comments	Insert				5/17/2007 2:39 PM
Terminations	Termination Date	Insert				5/17/2007 2:39 PM
Terminations	Termination Effective Date	Insert				5/17/2007 2:39 PM
Terminations	Termination Reason	Insert				5/17/2007 2:39 PM
Details	Comments Public	Insert			3/9/07 - NAME CHANGE FROM SISTERS OF CHARITY DBA BAYLEY SETON HOSPITAL	5/17/2007 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	11/16/2005 8:05 AM
Medicaid Billing	Medicaid: Number	Insert			00248820	11/16/2005 8:05 AM
Medicaid Billing	Medicaid: State	Insert			NY	11/16/2005 8:05 AM