Covered Entity Details

DSH330014A JAMAICA HOSPITAL MEDICAL CENTER (Active) - information as of 4/29/2025 11:55:36 PM

Main Details

Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330014A

Medicare Provider Number

330014

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/19/2006

Participating Start Date

1/1/2007

Participating Approval Date

10/19/2006

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Jamaica Hospital
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Primary Contact

Jamaica Hospital Medical Center
Louis Cosenza, Director
(718) 206-6052

Addresses

Street Address

133-03 JAMAICA AVENUE
RICHMOND HILLS, NY 11418

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	00243852	1245370717

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AN-NOOR PHARMACY INC	35 101ST AVE		BROOKLYN	NY	11208	01/11/2019	04/01/2019	01/12/2023	02/08/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/08/2020	04/01/2020	01/13/2020	01/13/2020
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/07/2017	10/01/2017		10/01/2017
Contract Detail	DUANE READE	84-32 JAMAICA AVENUE		WOODHAVEN	NY	11421	07/07/2017	10/01/2017		10/01/2017
Contract Detail	DUANE READE	103-09 LIBERTY AVENUE		OZONE PARK	NY	11417-1728	07/07/2017	10/01/2017		10/01/2017
Contract Detail	DULARI CORP.	QUEENS DRUGS & SURGICAL	146-14 JAMAICA AVE ATTN: SUPERVISING PHARMACIST	JAMAICA	NY	11435-3628	01/11/2019	04/01/2019		10/28/2019
Contract Detail	JAMAICARX INC	JAMAICA HOSPITAL MEDICAL CENTER	89-36 VAN WYCK EXPRESSWAY	JAMAICA	NY	11418	01/08/2019	04/01/2019		10/28/2019
Contract Detail	JAMAICARX, INC.	D/B/A MEDISYS RX PHARMACY	90-09 VAN WYCK EXPY	JAMAICA	NY	11435	01/11/2019	04/01/2019		10/28/2019
Contract Detail	JAMAICARX, INC.	CLOCK TOWER PHARMACY	91-20 ATLANTIC AVE	OZONE PARK	NY	11416	01/11/2019	04/01/2019		10/28/2019
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01312	1111 NORTH 9TH ST.	STROUDSBURG	PA	18360	07/06/2020	10/01/2020	07/06/2020	07/06/2020
Contract Detail	PRIMARY CARE PHARMACY INC	90-20 SUTPHIN BLVD		JAMAICA	NY	11435	01/11/2019	04/01/2019		10/28/2019
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/07/2017	10/01/2017		10/01/2017
Contract Detail	SREEPATHI PHARMACY INC	D/B/A METRO DRUGS	134-02 JAMAICA AVE	JAMAICA	NY	11418-2654	04/18/2013	04/18/2013	10/14/2015	10/28/2019
Contract Detail	SREEPATHI PHARMACY INC	D/B/A METRO DRUGS	134-02 JAMAICA AVE	JAMAICA	NY	11418-2654	10/12/2018	01/01/2019	10/11/2022	02/08/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04445	119-02 ROCKAWAY BLVD.	SOUTH OZONE PARK	NY	11420	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04565	12704 GUY R BREWER BLVD	JAMAICA	NY	11434	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04564	159-34 JAMAICA AVE	JAMAICA	NY	11432-6001	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	132-50 METROPOLITAN AVE.	RICHMOND HILL	NY	11418	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	175-06 HILLSIDE AVE.	JAMAICA	NY	11432	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	112-55 FARMERS BLVD.	JAMAICA	NY	11412	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05051	21914 MERRICK BLVD	LAURELTON	NY	11413	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS	1242 LIBERTY AVE.	BROOKLYN	NY	11208	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	145-80 FARMERS BLVD.	JAMAICA	NY	11434	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02055	109-62 FRANCIS LEWIS BLVD	QUEENS VILLAGE	NY	11429	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/07/2017	10/01/2017	03/27/2019	03/27/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/07/2017	10/01/2017	03/27/2019	03/27/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330014A	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER	133-03 JAMAICA AVENUE	RICHMOND HILLS	NY	Active
DSH330014C	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOLLIS)	188-03 Jamaica Avenue	HOLLIS	NY	Active
DSH330014D	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOWARD BEACH)	156-10 CROSSBAY BLVD.	HOWARD BEACH	NY	Active
DSH330014E	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (JAMAICA)	149-18 JAMAICA AVENUE	JAMAICA	NY	Active
DSH330014F	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (RICHMOND HILL)	133-03 JAMAICA AVENUE	RICHMOND HILL	NY	Active
DSH330014G	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014H	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS SENIOR HEALTH CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014K	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	The Jamaica Hospital Mental Health Clinic	90-09 VanWyck Expressway	JAMAICA	NY	Active
DSH330014L	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	130-02 115th Avenue	South Ozone Park	NY	Active
DSH330014M	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	207-01 116TH AVENUE	CAMBRIA HEIGHTS	NY	Active
DSH330014N	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	125-20 SUTPHIN BLVD	JAMAICA	NY	Active
DSH330014P	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	Jamaica Hospital Dental Clinic - Dental	134-20 Jamaica Ave	jamaica	NY	Active
DSH330014Q	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	St.Albans - clinic	111-20 Merrick Blvd	St.Albans	NY	Active
DSH330014R	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	East New York - OP Clinic	3080 Atlantic Ave	Brooklyn	NY	Active
DSH330014S	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	HOLLIS TUDOR - CLINIC	200-16 HOLLIS AVE	SAINT ALBANS	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 11:53:53 AM	8/14/2024 9:51:20 AM	8/14/2024 9:51 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 10:38:07 AM	8/15/2023 11:53:53 AM	8/15/2023 11:53 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 3:33:46 PM	8/29/2022 10:38:07 AM	8/29/2022 10:38 AM
Details	Last Recertification Date	Update	Recertification	9/2/2020 3:48:01 PM	8/23/2021 3:33:46 PM	8/23/2021 3:33 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245370717	9/2/2020 3:48 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/2/2020 3:48 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1245370717 ( )		9/2/2020 3:48 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 3:29:28 PM	9/2/2020 3:48:01 PM	9/2/2020 3:48 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 3:38:59 PM	8/21/2019 3:29:28 PM	8/21/2019 3:29 PM
Details	Last Recertification Date	Update	Recertification	11/14/2017 10:03:06 AM	8/21/2018 3:38:59 PM	8/21/2018 3:38 PM
Contacts	Primary Contact	Update	Change Request	PANTALEO, NICHOLAS DIRECTOR OF PHARMACY Jamaica Hospital Medical Center 7182066090	Cosenza, Louis Director Jamaica Hospital Medical Center 7182066052	7/10/2018 10:40 AM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/14/2017 10:03:06 AM	11/14/2017 10:03 AM
Contacts	Primary Contact	Update		PANTALEO, NICHOLAS DIRECTOR OF PHARMACY 7182066090	PANTALEO, NICHOLAS DIRECTOR OF PHARMACY Jamaica Hospital Medical Center 7182066090	10/3/2017 2:28 PM
Contacts	Authorizing Official	Update		DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/2/2017 2:49 PM
Contacts	Authorizing Official	Insert			DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	7/7/2017 3:56 PM
Contacts	Primary Contact	Update		FERRENTINO, LINDA ADMINISTRATOR 7182916372	PANTALEO, NICHOLAS DIRECTOR OF PHARMACY 7182066090	6/26/2017 6:24 PM
Addresses	Main Address	Insert			133-03 JAMAICA AVENUE RICHMOND HILLS, NY 11418	3/3/2017 4:45 PM
Details	Last Recertification Date	Update		9/3/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/23/2016 9:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/13/2015 6:07 PM
Medicaid Billing	Medicaid: Number	Insert			00243852	10/13/2015 6:07 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/13/2015 6:07 PM
Medicaid Billing	NPI: Number	Insert			1245370717	9/3/2015 10:47 AM
Details	Last Recertification Date	Update		8/12/2014 12:00:00 AM	9/3/2015 12:00:00 AM	9/3/2015 10:47 AM
Contacts	Primary Contact	Insert			FERRENTINO, LINDA ADMINISTRATOR 7182916372	8/12/2014 9:35 AM
Details	Last Recertification Date	Update		9/5/2013 1:19:01 PM	8/12/2014 12:00:00 AM	8/12/2014 9:35 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 1:19:01 PM	9/5/2013 1:19 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/30/2012 7:29 AM
Details	Last Recertification Date	Insert				10/19/2006 2:26 PM
Details	Grant Number	Insert				10/19/2006 2:26 PM
Details	340B ID	Insert			DSH330014A	10/19/2006 2:26 PM
Details	Is Authorizing Official EHB Data	Insert				10/19/2006 2:26 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/19/2006 2:26 PM
Details	Medicare Provider Number	Insert			330014	10/19/2006 2:26 PM
Details	Entity Name	Insert			JAMAICA HOSPITAL MEDICAL CENTER	10/19/2006 2:26 PM
Details	Program Code	Insert			DSH	10/19/2006 2:26 PM
Details	Entity Subname	Insert			THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER	10/19/2006 2:26 PM
Dates	Participating Approval Date	Insert			10/19/2006 12:00:00 AM	10/19/2006 2:26 PM
Details	State	Insert			Active	10/19/2006 2:26 PM
Dates	Registration Date	Insert			10/19/2006 12:00:00 AM	10/19/2006 2:26 PM
Dates	Signed By Date	Insert			8/25/2006 12:00:00 AM	10/19/2006 2:26 PM
Dates	Start Date	Insert			1/1/2007 12:00:00 AM	10/19/2006 2:26 PM
Terminations	Termination Comments	Insert				10/19/2006 2:26 PM
Terminations	Termination Date	Insert				10/19/2006 2:26 PM
Terminations	Termination Effective Date	Insert				10/19/2006 2:26 PM
Terminations	Termination Reason	Insert				10/19/2006 2:26 PM