340B Drug Pricing Program Database


DSH330024 THE MOUNT SINAI HOSPITAL (Active) - information as of 4/24/2025 11:12:45 PM

Main Details
THE MOUNT SINAI HOSPITAL
Disproportionate Share Hospital
No
DSH330024
330024


Additional Details
Active
5/10/2006
7/1/2004
5/10/2006
8/12/2024

Contacts

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

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

Addresses

ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
5/10/06 - REPLACES DSH1002905/10/2006
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NY02998589,02998612,002435091932103413,1417925181
Shipping Addresses

Safecor Health
317 New Boston St
Suite 100
Woburn, MA 01801

The Mount Sinai Hospital
101St between Madison Avenue and Fifth Avenue
New York, NY 10029

Mount Sinai Specialty Pharmacy
1468 Madison Ave
Annenberg - MC Level
New York, NY 10029

St. Luke's Roosevelt Hospital Center - West Village Pharmacy
275 7th Avenue
12th Floor
New York, NY 10001

St. Luke's Roosevelt Hospital Center C/O Outpatient Pharmacy
1000 Tenth Avenue
2nd Floor
New York, NY 10019

The Mount Sinai Hospital, d/b/a Mount Sinai Pharmacy at CAM
17 East 102nd St
3rd Floor
New York, NY 10029

Mount Sinai Home Infusion Pharmacy
1111 Amsterdam Ave
10th floor Clark Building, Suite 8-1003
New York, NY 10025

Mount Sinai Pharmacy on Madison
1407 Madison Avenue
New York, NY 10029

Mount Sinai Pharmacy - Harlem Health Center
158 West 124th St
New York, NY 10027

Mount Sinai Pharmacy - Crescent Street
30-14 Crescent Street
Astoria, NY 11102
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract Detail2355 2ND AVE NYS LLC2355 2ND AVE
NEW YORKNY1003507/15/201610/01/2016  07/24/2017
Contract DetailACARIAHEALTH PHARMACY #12, INC.5 SKYLINE DR STE 240
HAWTHORNENY10532-216610/06/201501/01/2016 01/07/202501/07/2025
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/15/201501/01/2016  07/24/2017
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/14/201601/01/2017  07/24/2017
Contract DetailACCREDO HEALTH GROUP INC201 GREAT CIRCLE ROAD
NASHVILLETN3722810/14/201601/01/2017 01/03/201901/03/2019
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/08/202010/23/2020  10/23/2020
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/15/201501/01/2016  07/24/2017
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/14/201601/01/2017  07/24/2017
Contract DetailACCREDO HEALTH GROUP, INC.45 ROUTE 46 EAST SUITE 609
PINE BROOKNJ0705804/05/202104/07/2021  04/07/2021
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/05/202104/07/2021 07/23/202407/23/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/10/202201/14/2022  01/14/2022
Contract DetailACRO PHARMACEUTICAL SERVICES LLCACRO PHARMACEUTICAL SERVICES LLC 313 HENDERSON DR
SHARON HILLPA1907910/14/201601/01/2017 06/27/201906/28/2019
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280907/18/201710/01/2017 06/27/201906/28/2019
Contract DetailAMERITA OF NEW YORK, LLCD/B/A AMERITA 75 NASSAU TERMINAL RD
STE 100 		NEW HYDE PARKNY11040-499710/04/201901/01/2020  01/01/2020
Contract DetailARROW APOTHECARY CORPARROW APOTHECARY 883 9TH AVE
NEW YORKNY1001910/02/202401/01/2025  01/01/2025
Contract DetailARROW PHARMACY INC883 NINTH AVE
NEW YORKNY10019-170404/23/201807/01/2018 10/02/202410/02/2024
Contract DetailASTORIA CHEMISTS2501 30TH AVE.
ASTORIANY1110207/12/201910/01/2019  10/01/2019
Contract DetailBIOLOGICS, INC.BIOLOGICS BY MCKESSON 11800 WESTON PARKWAY
CARYNC2751310/15/202010/23/2020  10/23/2020
Contract DetailBIOSCRIP INFUSION SERVICES, LLC PHARMACY6 VREELAND RD STE 103
FLORHAM PARKNJ0793201/14/202004/01/2020  04/01/2020
Contract DetailBLONDELL RX CORPD/B/A QUICK RX SPECIALTY PHARMACY 1642 EASTCHESTER ROAD
BRONXNY10461-231604/23/201807/01/2018 07/23/202407/23/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/15/202004/20/2020  04/20/2020
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/14/201607/01/2016  07/24/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/14/201607/01/2016  07/24/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/14/201607/01/2016  07/24/2017
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/14/202107/21/2021  07/21/2021
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/14/201607/01/2016  07/24/2017
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/15/202004/20/2020  04/20/2020
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/14/201607/01/2016  07/24/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/14/202107/21/2021  07/21/2021
Contract DetailCASTLETON PHARMACY CORP.DBA: ENEXIA SPECIALTY 252 PORT RICHMOND AVE
STATEN ISLANDNY10302-174907/31/201810/01/2018 07/23/202407/23/2024
Contract DetailCEDRA PHARMACY INC.3027 3RD AVE
BRONXNY10455-264710/15/202010/23/2020  10/23/2020
Contract DetailCITY DRUGS NY CORP.D/B/A CITY DRUGS 1551 YORK AVE
NEW YORKNY10028-602210/17/201601/01/2017 07/23/202407/23/2024
Contract DetailCOMMCARE PHARMACY-FTL, LLC855 SW 78TH AVE STE C100
PLANTATIONFL33324-322301/10/201404/01/2014 07/23/201907/23/2019
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 6 SPRING MILL DR
MALVERNPA1935510/05/202201/01/2023  01/01/2023
Contract DetailCORAM HEALTHCARE CORPORATION OF GREATERDBA CORAM CVS/SPECIALTY INFUSION SERVICE 12 JUPITER LANE
ALBANYNY12205-691801/15/201704/01/2017 10/05/202210/05/2022
Contract DetailCORAM HEALTHCARE CORPORATION OF GREATERDBA CORAM CVS/SPECIALTY INFUSION SERVICE 48-23 55TH AVENUE
MASPETHNY1137801/15/201704/01/2017 10/05/202210/05/2022
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02036 1622 THIRD AVE, BOROUGH OF MANHATTAN
NEW YORKNY1012810/27/201401/01/2015  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02445 540 AMSTERDAM AVENUE
NEW YORKNY1002410/27/201401/01/2015  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 03224 130 LENOX AVE.
NEW YORKNY1002610/27/201401/01/2015  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 05772 1500 LEXINGTON AVE.
NEW YORKNY1002910/27/201401/01/2015  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02360 743 AMSTERDAM AVENUE
NEW YORKNY1002507/16/201710/01/2017  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02411 1569 FIRST AVENUE
NEW YORKNY1002807/16/201710/01/2017  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02557 253 FIRST AVENUE
NEW YORKNY1000307/16/201710/01/2017  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02717 1294 LEXINGTON AVE.
NEW YORKNY1012807/16/201710/01/2017  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 06062 200 WEST END AVENUE
MANHATTANNY1002307/16/201710/01/2017  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 06066 2495 BROADWAY
NEW YORKNY1002507/16/201710/01/2017  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 00601 272 8TH AVENUE
NEW YORKNY1001107/16/201710/01/2017 09/20/202209/20/2022
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02144 1396 SECOND AVENUE
NEW YORKNY1002107/16/201710/01/2017  07/24/2017
Contract DetailCVS ALBANY, L.L.C.DBA CVS/PHARMACY # 3146 30-97 STEINWAY ST.
ASTORIANY1110307/12/201910/01/2019  10/01/2019
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY #07576 3101 DITMARS BLVD.
ASTORIANY1110507/12/201910/01/2019  10/01/2019
Contract DetailCVS ALBANY, L.L.C.DBA CVS/PHARMACY # 10298 241 WEST 57TH STREET
NEW YORKNY1001904/15/202004/20/2020  04/20/2020
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02737 115 W. 125TH STREET
NEW YORKNY1002704/15/202004/20/2020  04/20/2020
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 02940 500 W. 42ND ST.
NEW YORKNY1003604/15/202004/20/2020  04/20/2020
Contract DetailCVS ALBANY, L.L.C.DBA: CVS/PHARMACY # 01113 89-11 NORTHERN BLVD.
JACKSON HEIGHTSNY1137207/14/202107/21/2021  07/21/2021
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/14/202107/21/2021  07/21/2021
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/14/202107/21/2021  07/21/2021
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268307/10/202007/21/2020  07/21/2020
Contract DetailDRUG MART SOLUTIONS LLCD/B/A QUALITY RX 1611 UNIVERSITY AVENUE
BRONXNY1045307/14/201610/01/2016 05/09/202205/09/2022
Contract DetailDUANE READE33 7TH AVENUE
NEW YORKNY10011-660204/15/201607/01/2016 10/14/201910/14/2019
Contract DetailDUANE READE2108 3RD AVENUE
NEW YORKNY10029-210304/15/201607/01/2016 12/14/201701/29/2018
Contract DetailDUANE READE1498 YORK AVENUE
NEW YORKNY1007504/15/201607/01/2016  07/24/2017
Contract DetailDUANE READE721 9TH AVE
NEW YORKNY1001904/15/201607/01/2016  07/24/2017
Contract DetailDUANE READE777 AVENUE OF THE AMERICAS FRNT 2
NEW YORKNY1000104/15/201607/01/2016  07/24/2017
Contract DetailDUANE READE1915 THIRD AVE
NEW YORKNY1002904/15/201607/01/2016  07/24/2017
Contract DetailDUANE READE1675 THIRD AVE
NEW YORKNY1012804/15/201607/01/2016 11/17/202211/17/2022
Contract DetailDUANE READE320 W 145TH STREET
NEW YORKNY1003904/15/201607/01/2016  07/24/2017
Contract DetailDUANE READE333 EAST 102ND STREET
NEW YORKNY10029-560204/15/201607/01/2016 12/14/201701/29/2018
Contract DetailDUANE READE1490 MADISON AVENUE
NEW YORKNY10029-450204/15/201607/01/2016 04/01/202504/01/2025
Contract DetailDUANE READE224 W. 29TH STREET
NEW YORKNY1000104/15/201607/01/2016 06/27/201906/28/2019
Contract DetailDUANE READE135 EAST 125TH STREET
NEW YORKNY1003504/23/201807/01/2018 11/17/202211/17/2022
Contract DetailDUANE READEDBA DUANE READE 1111 3RD AVE FL 1
NEW YORKNY1006504/23/201807/01/2018  04/23/2018
Contract DetailDUANE READE315 W 23RD ST
NEW YORKNY10011-224704/23/201807/01/2018 12/02/201912/02/2019
Contract DetailDUANE READE333 7TH AVENUE
NEW YORKNY1000104/23/201807/01/2018  04/23/2018
Contract DetailDUANE READEDBA DUANE READE 37-66 82ND ST.
JACKSON HEIGHTSNY1137204/23/201807/01/2018  04/23/2018
Contract DetailDUANE READE1749-53 FIRST AVE
NEW YORKNY1012804/23/201807/01/2018 10/14/201910/14/2019
Contract DetailDUANE READE2864 BROADWAY
NEW YORKNY1002504/23/201807/01/2018  04/23/2018
Contract DetailDUANE READE131 8TH AVE
NEW YORKNY1001104/23/201807/01/2018 12/02/201912/02/2019
Contract DetailELENI INTERNATIONAL, INCDBA NEW LONDON SPECIALTY PHARMACY 246 8TH AVE
2ND FLOOR SUITE A 		NEW YORKNY1001107/19/201610/01/2016  07/24/2017
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/15/201710/01/2017  07/24/2017
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 255 PHILLIPI ROAD
COLUMBUSOH4322807/15/201710/01/2017 06/18/201807/31/2018
Contract DetailICAHN SCHOOL OF MEDICINE AT MOUNT SINAIICAHN SCHOOL OF MEDICINE PHARMACY 1468 MADISON AVE
ANNENBERG-MC LEVEL 		NEW YORKNY1002904/18/201607/01/2016 08/27/202008/27/2020
Contract DetailKINGS PARK SLOPE INCD/B/A KINGS SUPER PHARMACY 357 FLATBUSH AVE
BROOKLYNNY1123804/15/201607/01/2016 07/23/202407/23/2024
Contract DetailMADISON AVENUE PHARMACY INC.1407 MADISON AVE
NEW YORKNY10029-693010/05/201210/05/2012 01/31/201804/23/2018
Contract DetailMAGELLAN RX PHARMACY, LLC.31-75 23RD STREET SUITE 410
ASTORIANY1110607/18/201610/01/2016 07/15/201607/24/2017
Contract DetailNEW LONDON PHARMACY INC246 8TH AVE
NEW YORKNY10011-164607/14/201610/01/2016  07/24/2017
Contract DetailNEXTRON INFUSION SERVICES11 COMMERCE WAY STE H
TOTOWANJ0751204/04/201907/01/2019  07/01/2019
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 11403 BLUEGRASS PARKWAY
SUITE 400 		LOUISVILLEKY40299-239801/14/202004/01/2020  04/01/2020
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/11/202004/15/2020  04/15/2020
Contract DetailOPTUM INFUSION SERVICES 101, INC.931 CONKLIN ST STE D
FARMINGDALENY11735-242907/10/202007/21/2020  07/21/2020
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/11/202004/15/2020  04/15/2020
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/12/202204/13/2022  04/19/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520407/01/202410/01/2024  10/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/11/201907/01/2019  07/01/2019
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/11/202004/15/2020  04/15/2020
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/11/201907/01/2019  07/01/2019
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/11/201907/01/2019  07/01/2019
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/11/202004/15/2020  04/15/2020
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660810/08/202010/23/2020 10/06/202210/06/2022
Contract DetailPRIME AID PHARMACY INC.3915 BERGENLINE AVENUE
UNION CITYNJ07087-089907/18/201610/01/2016 10/01/201701/29/2018
Contract DetailPRIME THERAPEUTICS PHARMACY LLC6870 SHADOWRIDGE DR STE 111
ORLANDOFL3281207/18/201610/01/2016 07/15/201607/24/2017
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/14/201401/01/2015  07/24/2017
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY # 2919 126 EIGHTH AVE.
NEW YORKNY1001104/17/201707/01/2017  07/24/2017
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104207/12/201910/01/2019  10/01/2019
Contract DetailST LUKE'S ROOSEVELT HOSPITAL CENTERMOUNT SINAI PHARMACY - CHELSEA 275 7TH AVE FL 12
NEW YORKNY1000110/14/201501/01/2016 08/27/202008/27/2020
Contract DetailST LUKES ROOSEVELT HOSPITAL CENTERC/O OUTPATIENT PHARMACY 1000 10TH AVE FL 2
NEW YORKNY1001910/14/201501/01/2016 08/27/202008/27/2020
Contract DetailTOTAL CARE RX, INC.WORLD'S FAIR PHARMACY 22310 UNION TPKE
OAKLAND GARDENSNY11364-364507/14/202107/21/2021  07/21/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01180 3355 CRESCENT ST # 67
LONG ISLAND CITYNY1110604/15/201607/01/2016 11/09/202311/09/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01214 1328 2ND AVE
NEW YORKNY1002104/15/201607/01/2016  07/24/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16512 3462 JEROME AVE.
BRONXNY1046704/15/201607/01/2016 12/18/201812/18/2018
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16078 205 8TH AVENUE
NEW YORKNY1001104/15/201607/01/2016  07/24/2017
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH330024AChildDSHTHE MOUNT SINAI HOSPITAL 25-10 30TH AVENUELONG ISLAND CITYNYActive
DSH330024AAChildDSHTHE MOUNT SINAI HOSPITALMount Sinai Hospital - Martin Luther King Jr HS122 Amsterdam AveNew YorkNYActive
DSH330024ABChildDSHTHE MOUNT SINAI HOSPITALMount Sinai Hospital - Intermediate School 452351 First AvenueNew YorkNYActive
DSH330024ACChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Gastroenterology3014 CRESCENT STASTORIANYActive
DSH330024ADChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Liver3014 CRESCENT STASTORIANYActive
DSH330024AEChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Physical Therapy3014 CRESCENT STASTORIANYActive
DSH330024AFChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Hematology Oncology3014 CRESCENT STASTORIANYActive
DSH330024AGChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Rheumatology3014 CRESCENT STASTORIANYActive
DSH330024AHChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Endocrinology3014 CRESCENT STASTORIANYActive
DSH330024AJChildDSHTHE MOUNT SINAI HOSPITALMount Sinai Staten Island Cancer1441 South AvenueStaten IslandNYActive
DSH330024AKChildDSHTHE MOUNT SINAI HOSPITAL(MSQ CRESCENT) - Cardiology3014 CRESCENT STASTORIANYActive
DSH330024ALChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Institute of Advanced Medicine3014 CRESCENT STASTORIANYApproved
DSH330024AMChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI HOSPITAL (MSQ CRESCENT) - Express Care3014 CRESCENT STASTORIANYApproved
DSH330024BChildDSHTHE MOUNT SINAI HOSPITALPrimary Care Center31-60 21st streetAstoriaNYActive
DSH330024CChildDSHTHE MOUNT SINAI HOSPITALMOUNT SINAI QUEENS INFUSION27-15 30th AvenueLong Island CityNYTerminated
DSH330024FChildDSHTHE MOUNT SINAI HOSPITALManhattan Center for Math & ScienceFDR Drive & E 116th StreetNew YorkNYActive
DSH330024GChildDSHTHE MOUNT SINAI HOSPITALPS 83 Mendoza School219 East 109th StreetNew YorkNYActive
DSH330024HChildDSHTHE MOUNT SINAI HOSPITALJulia Richman High School317 E. 67th StreetNew YorkNYActive
DSH330024JChildDSHTHE MOUNT SINAI HOSPITALPS 38232 East 103rd StreetNew YorkNYActive
DSH330024KChildDSHTHE MOUNT SINAI HOSPITALJHS 117 (Alternative Education Complex)240 East 109th StreetNew YorkNYActive
DSH330024LChildDSHTHE MOUNT SINAI HOSPITALPS 1081615 Madison AvenueNew YorkNYActive
DSH330024MChildDSHTHE MOUNT SINAI HOSPITALBayard Rustin Education Complex (BREC)West 18th StreetNew YorkNYActive
DSH330024NChildDSHTHE MOUNT SINAI HOSPITALJoseph H. Hazan Amb. Cardiac Care Center5 East 98th StreetNew YorkNYTerminated
DSH330024PChildDSHTHE MOUNT SINAI HOSPITALMt. Sinai Sports Therapy Center625 Madison AvenueNew YorkNYTerminated
DSH330024QChildDSHTHE MOUNT SINAI HOSPITALMount Sinai Comprehensive Heath Program - Downtown275 Seventh AvenueNew YorkNYActive
DSH330024RChildDSHTHE MOUNT SINAI HOSPITALPsychiatric Out-Patient Clinic1160 Fifth AvenueNew YorkNYActive
DSH330024SChildDSHTHE MOUNT SINAI HOSPITALMt. Sinai Adolescent Health Center320 East 94th StreetNew YorkNYActive
DSH330024TChildDSHTHE MOUNT SINAI HOSPITALCenter of Advanced Medicine5 East 102nd StreetNew YorkNYTerminated
DSH330024UChildDSHTHE MOUNT SINAI HOSPITALMount Sinai Kidney Center520 East 117th StreetNew YorkNYActive
DSH330024VChildDSHTHE MOUNT SINAI HOSPITALJACKSON HEIGHTS EXTENSION CLINIC37-22 82nd StreetJackson HeightsNYActive
DSH330024WChildDSHTHE MOUNT SINAI HOSPITALMount Sinai Queens - Emergency Department25-10 30th AveLong Island CityNYActive
DSH330024XChildDSHTHE MOUNT SINAI HOSPITALMount Sinai Queens - Ambulatory Surgery25-10 30th AveLong Island CityNYActive
DSH330024YChildDSHTHE MOUNT SINAI HOSPITALLouis Brandeis HS - Louis Brandeis HS145 W 84th StNew YorkNYActive
DSH330024ZChildDSHTHE MOUNT SINAI HOSPITALA. Philip Randolph HS - A. Philip Randolph HS443 W 135th StNew YorkNYActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertChange Request Mount Sinai Pharmacy - Crescent Street 30-14 Crescent Street Astoria, NY 1110212/10/2024 10:10 AM
DetailsLast Recertification DateUpdateRecertification8/15/2023 11:04:34 AM8/12/2024 8:45:17 AM8/12/2024 8:45 AM
AddressesShipping AddressInsertChange Request Mount Sinai Pharmacy - Harlem Health Center 158 West 124th St New York, NY 100274/10/2024 9:45 AM
DetailsLast Recertification DateUpdateRecertification8/26/2022 1:10:09 PM8/15/2023 11:04:34 AM8/15/2023 11:04 AM
AddressesShipping AddressInsertChange Request Mount Sinai Pharmacy on Madison 1407 Madison Avenue New York, NY 1002910/19/2022 6:59 AM
DetailsLast Recertification DateUpdateRecertification8/18/2021 12:45:21 PM8/26/2022 1:10:09 PM8/26/2022 1:10 PM
AddressesShipping AddressInsertChange Request Mount Sinai Home Infusion Pharmacy 1111 Amsterdam Ave 10th floor Clark Building, Suite 8-1003 New York, NY 100255/11/2022 8:56 AM
AddressesShipping AddressUpdateChange RequestIcahn School of Medicine Pharmacy 1468 Madison Ave Annenberg - MC Level New York, NY 10029Mount Sinai Specialty Pharmacy 1468 Madison Ave Annenberg - MC Level New York, NY 1002911/9/2021 9:17 AM
DetailsLast Recertification DateUpdateRecertification9/7/2020 9:57:00 AM8/18/2021 12:45:21 PM8/18/2021 12:45 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/7/2020 1:02 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0299858912/7/2020 1:02 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/7/2020 1:02 PM
Medicaid BillingNPI: NumberInsertChange Request 141792518112/7/2020 1:02 PM
Medicaid BillingNPI: StateInsertChange Request NY12/7/2020 1:02 PM
AddressesShipping AddressInsertChange Request The Mount Sinai Hospital, d/b/a Mount Sinai Pharmacy at CAM 17 East 102nd St 3rd Floor New York, NY 1002912/3/2020 2:28 PM
Medicaid BillingNPI: StateUpdateRecertification NY9/7/2020 9:57 AM
DetailsLast Recertification DateUpdateRecertification8/20/2019 11:55:28 AM9/7/2020 9:57:00 AM9/7/2020 9:57 AM
AddressesShipping AddressInsertChange Request Icahn School of Medicine Pharmacy 1468 Madison Ave Annenberg - MC Level New York, NY 1002910/25/2019 1:15 PM
AddressesShipping AddressInsertChange Request St. Luke's Roosevelt Hospital Center - West Village Pharmacy 275 7th Avenue 12th Floor New York, NY 1000110/25/2019 1:15 PM
AddressesShipping AddressInsertChange Request St. Luke's Roosevelt Hospital Center C/O Outpatient Pharmacy 1000 Tenth Avenue 2nd Floor New York, NY 1001910/25/2019 1:15 PM
DetailsLast Recertification DateUpdateRecertification9/11/2018 7:36:02 AM8/20/2019 11:55:28 AM8/20/2019 11:55 AM
ContactsPrimary ContactUpdateProfile Change RequestWilhelm-Ross, Samuel 340B Program Director Mount Sinai Health System 7182674352Wilhelm-Ross, Samuel 340B Program Director Mount Sinai Health System 64660520065/14/2019 9:25 AM
ContactsPrimary ContactUpdateChange RequestManning, Philip Senior Director of Pharmacy mount sinai health system 7182674295Wilhelm-Ross, Samuel 340B Program Director Mount Sinai Health System 718267435211/19/2018 3:27 PM
ContactsAuthorizing OfficialUpdateChange RequestLamb, Patricia Chief, Ancillary Services Mount Sinai Health System 2122412095Pastier, Michael Senior VP/CFO - The Mount Sinai Hospital Mount Sinai 212731314910/29/2018 7:12 AM
DetailsLast Recertification DateUpdateRecertification12/4/2017 3:55:32 PM9/11/2018 7:36:02 AM9/11/2018 7:36 AM
DetailsLast Recertification DateUpdateRecertification8/21/2016 12:00:00 AM12/4/2017 3:55:32 PM12/4/2017 3:55 PM
ContactsPrimary ContactUpdateChange RequestKOVARIK, MARK DIR 2127313241Manning, Philip Senior Director of Pharmacy mount sinai health system 718267429510/24/2017 6:43 PM
ContactsAuthorizing OfficialInsertChange Request Lamb, Patricia Chief, Ancillary Services Mount Sinai Health System 212241209510/24/2017 6:43 PM
AddressesMain AddressInsert   ONE GUSTAVE L. LEVY PLACE NEW YORK, NY 100297/24/2017 6:49 PM
AddressesShipping AddressInsert  The Mount Sinai Hospital 101St between Madison Avenue and Fifth Avenue New York, NY 100297/24/2017 6:49 PM
AddressesShipping AddressInsert  Safecor Health 317 New Boston St Suite 100 Woburn, MA 018017/24/2017 6:49 PM
ContactsPrimary ContactInsert  KOVARIK, MARK DIR 21273132417/24/2017 6:49 PM
DetailsLast Recertification DateUpdate 8/25/2015 12:00:00 AM8/21/2016 12:00:00 AM8/21/2016 1:13 PM
DetailsLast Recertification DateUpdate 9/5/2014 12:00:00 AM8/25/2015 12:00:00 AM8/25/2015 1:25 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False9/24/2014 5:43 PM
Medicaid BillingMedicaid: NumberInsert  002435099/24/2014 5:43 PM
Medicaid BillingMedicaid: StateInsert  NY9/24/2014 5:43 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False9/5/2014 6:41 PM
Medicaid BillingMedicaid: NumberInsert  029986129/5/2014 6:41 PM
Medicaid BillingMedicaid: StateInsert  NY9/5/2014 6:41 PM
DetailsLast Recertification DateUpdate 8/29/2013 12:00:00 AM9/5/2014 12:00:00 AM9/5/2014 6:41 PM
Medicaid BillingNPI: NumberInsert  193210341312/26/2013 3:07 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/29/2013 12:00:00 AM8/29/2013 2:57 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/29/2012 2:25 PM
DetailsLast Recertification DateInsert   5/10/2006 12:21 PM
DetailsGrant NumberInsert   5/10/2006 12:21 PM
Details340B IDInsert  DSH3300245/10/2006 12:21 PM
DetailsIs Authorizing Official EHB DataInsert   5/10/2006 12:21 PM
DatesLast Date That 340B Drugs PurchasedInsert   5/10/2006 12:21 PM
DetailsMedicare Provider NumberInsert  3300245/10/2006 12:21 PM
DetailsEntity NameInsert  THE MOUNT SINAI HOSPITAL5/10/2006 12:21 PM
DetailsProgram CodeInsert  DSH5/10/2006 12:21 PM
DetailsEntity SubnameInsert   5/10/2006 12:21 PM
DatesParticipating Approval DateInsert  5/10/2006 12:00:00 AM5/10/2006 12:21 PM
DetailsStateInsert  Active5/10/2006 12:21 PM
DatesRegistration DateInsert  5/10/2006 12:00:00 AM5/10/2006 12:21 PM
DatesSigned By DateInsert   5/10/2006 12:21 PM
DatesStart DateInsert  7/1/2004 12:00:00 AM5/10/2006 12:21 PM
TerminationsTermination CommentsInsert   5/10/2006 12:21 PM
TerminationsTermination DateInsert   5/10/2006 12:21 PM
TerminationsTermination Effective DateInsert   5/10/2006 12:21 PM
TerminationsTermination ReasonInsert   5/10/2006 12:21 PM
DetailsComments PublicInsert  5/10/06 - REPLACES DSH100295/10/2006 12:21 PM