| Medicaid Billing | NPI: Number | Delete | Change Request | 1710977012 (PA) | | 9/12/2024 9:09 AM |
| Addresses | Main Address | Update | Recertification |
68 HARRIS BUSHVILLE ROAD
BUSHVILLE ROAD
HARRIS, NY 12742-0000 |
68 HARRIS BUSHVILLE ROAD
HARRIS, NY 12742-0000 | 9/4/2024 3:10 PM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2023 7:17:53 AM | 9/4/2024 3:10:16 PM | 9/4/2024 3:10 PM |
| Contacts | Primary Contact | Update | Recertification | Soirefman, Mark
Director of Pharmacy
Garnet Health Medical Center-Catskills
8457943300-2017 | Wilson, Shariyka
340B Program Manager
Garnet Health
8453332045 | 9/7/2023 7:17 AM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2022 8:47:44 AM | 9/7/2023 7:17:53 AM | 9/7/2023 7:17 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Dunlavey, Jerry
Chief Operating Officer
Garnet Health Medical Center - Catskills
8453332312 | Grigg, James
CFO
Garnet Health
8453332306 | 9/6/2023 1:24 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1710977012 | 9/30/2022 1:48 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | PA | 9/30/2022 1:48 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1710977012 | 9/30/2022 1:48 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | NJ | 9/30/2022 1:48 PM |
| Addresses | Main Address | Update | Recertification |
68 HARRIS-BUSHVILLE ROAD
BUSHVILLE ROAD
HARRIS, NY 12742-0000 |
68 HARRIS BUSHVILLE ROAD
BUSHVILLE ROAD
HARRIS, NY 12742-0000 | 9/8/2022 8:47 AM |
| Details | Last Recertification Date | Update | Recertification | 9/15/2021 10:42:42 AM | 9/8/2022 8:47:44 AM | 9/8/2022 8:47 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Schiller, Jonathan David
Chief Executive Officer
Garnet Health Medical Center - Catskills
8457943300-2100 | Dunlavey, Jerry
Chief Operating Officer
Garnet Health Medical Center - Catskills
8453332312 | 8/2/2022 7:31 AM |
| Contacts | Primary Contact | Update | Change Request | Soirefman, Mark
Director Of Pharmacy
CATSKILL REGIONAL MEDICAL CENTER
8457943300-2017 | Soirefman, Mark
Director of Pharmacy
Garnet Health Medical Center-Catskills
8457943300-2017 | 10/6/2021 1:30 PM |
| Contacts | Authorizing Official | Update | Change Request | Schiller, Jonathan
Chief Executive Officer
Catskill Regional Medical Center
8457943300-2100 | Schiller, Jonathan David
Chief Executive Officer
Garnet Health Medical Center - Catskills
8457943300-2100 | 10/6/2021 1:30 PM |
| Details | Last Recertification Date | Update | Recertification | 9/14/2020 3:34:38 PM | 9/15/2021 10:42:42 AM | 9/15/2021 10:42 AM |
| Addresses | Billing Address | Update | Recertification | Catskill Regional Medical Center Attention Accounts Payable
707 East Main Street
Middletown, NY 10940 | Garnet Health Medical Center - Catskills, Attention Accounts Payable
707 East Main Street
Middletown, NY 10940 | 9/14/2020 3:34 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | NY | 9/14/2020 3:34 PM |
| Details | Last Recertification Date | Update | Recertification | 9/9/2019 7:27:58 AM | 9/14/2020 3:34:38 PM | 9/14/2020 3:34 PM |
| Details | Entity Name | Update | Recertification | CATSKILL REGIONAL MEDICAL CENTER | Garnet Health Medical Center - Catskills | 9/14/2020 3:34 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2018 10:15:39 AM | 9/9/2019 7:27:58 AM | 9/9/2019 7:27 AM |
| Addresses | Billing Address | Insert | Change Request | | Catskill Regional Medical Center Attention Accounts Payable
707 East Main Street
Middletown, NY 10940 | 8/15/2019 7:30 AM |
| Contacts | Primary Contact | Update | Change Request | Soirefman, Mark
Director Of Pharmacy
Catskill Regional Medical Center
8457943300-2017 | Soirefman, Mark
Director Of Pharmacy
CATSKILL REGIONAL MEDICAL CENTER
8457943300-2017 | 8/15/2019 7:30 AM |
| Details | Last Recertification Date | Update | Recertification | 11/15/2017 10:13:56 PM | 8/24/2018 10:15:39 AM | 8/24/2018 10:15 AM |
| Details | Last Recertification Date | Update | Recertification | 8/11/2016 12:00:00 AM | 11/15/2017 10:13:56 PM | 11/15/2017 10:13 PM |
| Contacts | Primary Contact | Update | Recertification | Soirefman, Mark
Director Of Pharmacy
8457943300-2017 | Soirefman, Mark
Director Of Pharmacy
Catskill Regional Medical Center
8457943300-2017 | 11/10/2017 11:32 AM |
| Contacts | Authorizing Official | Update | | Schiller, Jonathan
Chief Executive Officer
8457943300-2100 | Schiller, Jonathan
Chief Executive Officer
Catskill Regional Medical Center
8457943300-2100 | 11/6/2017 3:21 PM |
| Contacts | Authorizing Official | Update | | GALARNEAU, GERARD
Chief Executive Officer
8457943300-3225 | Schiller, Jonathan
Chief Executive Officer
8457943300-2100 | 8/7/2017 8:12 AM |
| Contacts | Primary Contact | Update | | RUWOLDT, STEVEN T.
CEO
8457943300-3225 | Soirefman, Mark
Director Of Pharmacy
8457943300-2017 | 8/7/2017 8:12 AM |
| Addresses | Main Address | Insert | | |
68 HARRIS-BUSHVILLE ROAD
BUSHVILLE ROAD
HARRIS, NY 12742-0000 | 8/7/2017 8:12 AM |
| Contacts | Authorizing Official | Update | | RUWOLDT, STEVEN T.
CEO
8457943300-3225 | GALARNEAU, GERARD
Chief Executive Officer
8457943300-3225 | 5/23/2017 5:27 PM |
| Details | Last Recertification Date | Update | | 8/12/2015 12:00:00 AM | 8/11/2016 12:00:00 AM | 8/11/2016 9:57 AM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 8/12/2015 10:32 AM |
| Details | Last Recertification Date | Update | | 8/20/2014 12:00:00 AM | 8/12/2015 12:00:00 AM | 8/12/2015 10:32 AM |
| Details | Last Recertification Date | Update | | 9/11/2013 12:00:00 AM | 8/20/2014 12:00:00 AM | 8/20/2014 2:04 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1710977012 | 9/11/2013 11:05 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/11/2013 12:00:00 AM | 9/11/2013 11:05 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/22/2012 12:40 PM |
| Contacts | Authorizing Official | Insert | | | RUWOLDT, STEVEN T.
CEO
8457943300-3225 | 9/9/2008 6:38 AM |
| Contacts | Primary Contact | Insert | | | RUWOLDT, STEVEN T.
CEO
8457943300-3225 | 9/9/2008 6:38 AM |
| Details | Last Recertification Date | Insert | | | | 9/9/2008 6:38 AM |
| Details | Grant Number | Insert | | | | 9/9/2008 6:38 AM |
| Details | 340B ID | Insert | | | DSH330386 | 9/9/2008 6:38 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/9/2008 6:38 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/9/2008 6:38 AM |
| Details | Medicare Provider Number | Insert | | | 330386 | 9/9/2008 6:38 AM |
| Details | Entity Name | Insert | | | CATSKILL REGIONAL MEDICAL CENTER | 9/9/2008 6:38 AM |
| Details | Program Code | Insert | | | DSH | 9/9/2008 6:38 AM |
| Details | Entity Subname | Insert | | | | 9/9/2008 6:38 AM |
| Dates | Participating Approval Date | Insert | | | 12/14/2006 12:00:00 AM | 9/9/2008 6:38 AM |
| Details | State | Insert | | | Active | 9/9/2008 6:38 AM |
| Dates | Registration Date | Insert | | | 12/14/2006 12:00:00 AM | 9/9/2008 6:38 AM |
| Dates | Signed By Date | Insert | | | | 9/9/2008 6:38 AM |
| Dates | Start Date | Insert | | | 1/1/2007 12:00:00 AM | 9/9/2008 6:38 AM |
| Terminations | Termination Comments | Insert | | | | 9/9/2008 6:38 AM |
| Terminations | Termination Date | Insert | | | | 9/9/2008 6:38 AM |
| Terminations | Termination Effective Date | Insert | | | | 9/9/2008 6:38 AM |
| Terminations | Termination Reason | Insert | | | | 9/9/2008 6:38 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 12/14/2006 10:33 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 00273978 | 12/14/2006 10:33 AM |
| Medicaid Billing | Medicaid: State | Insert | | | NY | 12/14/2006 10:33 AM |