Covered Entity Details

DSH330065C NIAGARA FALLS MEMORIAL MEDICAL CENTER (Active) - information as of 5/20/2025 12:49:43 AM

Main Details

Name

NIAGARA FALLS MEMORIAL MEDICAL CENTER

Subdivision Name

PORTER ROAD LABORATORY DRAW STATION

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330065C

Medicare Provider Number

330065

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

6/13/2007

Participating Start Date

7/1/2007

Participating Approval Date

6/14/2007

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

Niagara Falls Memorial Medical Center
Matthew DuBois, VP & CFO
(716) 278-4399

Primary Contact

Niagara Falls Memorial Medical Center
Julie Czyzewski, 340B Coordinator
(716) 278-4450

Addresses

Street Address

7751 PORTER ROAD
NIAGARA FALLS, NY 14304

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	00354467	1285717298

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	SUMMIT PARK PHARMACY	2578 NIAGRA FALLS BLVD	SUITE 100	NIAGRA FALLS	NY	14304	08/17/2010	08/17/2010	08/16/2016
Contract Detail	TOPS MARKETS	2140 GRAND ISLAND BLVD		GRAND ISLAND	NY	14072	08/06/2010	08/06/2010	08/16/2016
Contract Detail	WEGMANS FOOD MARKETS, INC.	1577 MILITARY ROAD	ATTN: PHARMACY	NIAGARA FALLS	NY	14304	09/25/2009	09/25/2009	08/16/2016

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330065A	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	SUMMIT HEALTH FAMILY PRACTICE	6932-6934 WILLIAMS RD	Niagara Falls	NY	Active
DSH330065C	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	PORTER ROAD LABORATORY DRAW STATION	7751 PORTER ROAD	NIAGARA FALLS	NY	Active
DSH330065D	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	GRAND ISLAND FAMILY PRACTICE	2608 Grand Island Blvd	GRAND ISLAND	NY	Terminated
DSH330065E	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	Niagara Falls Primary Care Clinic	533 Tenth St Suite 100C	Niagara Falls	NY	Active
DSH330065F	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	North Tonawanda Primary Care Center	1089 Kinkead Ave, Suite 111	North Tonawanda	NY	Terminated
DSH330065G	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	Lewiston Primary Care Center	4600 Military Road	Niagara Falls	NY	Active
DSH330065H	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	Niagara Metabolic and Bariatric Services - Metabolic and Bariatric Services	620 10th Street	Niagara Falls	NY	Terminated
DSH330065J	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	Emergency Services - Emergency Department	571 10th Street	Niagara Falls	NY	Active
DSH330065K	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	The Wound Center of Niagara - Wound Care	620 10th Street	Niagara Falls	NY	Active
DSH330065L	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	The Heart Center of Niagara - Cardiac Services	571 10th street	Niagara Falls	NY	Active
DSH330065M	Child	DSH	NIAGARA FALLS MEMORIAL MEDICAL CENTER	Controlled Substance Clinic - Clinic	620 Tenth St	Niagara Falls	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Braun Jr, Richard G EVP Chief Financial Officer Niagara Falls Memorial Medical Center 7169089333	DuBois, Matthew VP & CFO Niagara Falls Memorial Medical Center 7162784399	10/30/2024 8:34 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 1:44:39 PM	8/26/2024 10:00:41 AM	8/26/2024 10:00 AM
Contacts	Primary Contact	Update	PC Change Request	Latuga, Thomas Pharmacy Finance and 340B Coordinator Niagara Falls Memorial Medical Center 7162784450	Czyzewski, Julie 340B Coordinator Niagara Falls Memorial Medical Center 7162784450	1/23/2024 7:06 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 9:00:34 AM	8/16/2023 1:44:39 PM	8/16/2023 1:44 PM
Details	Last Recertification Date	Update	Recertification	9/8/2021 9:23:24 AM	8/26/2022 9:00:34 AM	8/26/2022 9:00 AM
Contacts	Authorizing Official	Update	Change Request	Wright, Mark Senior Vice President/Finance Niagara Falls Memorial Medical Center 7162784399	Braun Jr, Richard G EVP Chief Financial Officer Niagara Falls Memorial Medical Center 7169089333	5/31/2022 2:57 PM
Contacts	Primary Contact	Update	Change Request	Balbo, Marybeth 340B Program Coordinator Niagara Falls Memorial Medical Center 7162784537	Latuga, Thomas Pharmacy Finance and 340B Coordinator Niagara Falls Memorial Medical Center 7162784450	12/7/2021 1:28 PM
Details	Last Recertification Date	Update	Recertification	9/1/2020 11:22:31 AM	9/8/2021 9:23:24 AM	9/8/2021 9:23 AM
Contacts	Primary Contact	Update	Change Request	Lewis, Michelle A Director of Pharmacy Niagara Falls Memorial Medical Center 7162784455	Balbo, Marybeth 340B Program Coordinator Niagara Falls Memorial Medical Center 7162784537	11/18/2020 7:57 AM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 11:22 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 8:46:35 PM	9/1/2020 11:22:31 AM	9/1/2020 11:22 AM
Contacts	Primary Contact	Update	Profile Change Request	Lewis, Michelle D Director of Pharmacy Niagara Falls Memorial Medical Center 7162784455	Lewis, Michelle A Director of Pharmacy Niagara Falls Memorial Medical Center 7162784455	8/30/2019 8:31 PM
Contacts	Primary Contact	Update	Recertification	Greer, Tristan 340B Coordinator Niagara Falls Memorial Medical Center 7162784537	Lewis, Michelle D Director of Pharmacy Niagara Falls Memorial Medical Center 7162784455	8/21/2019 8:46 PM
Details	Last Recertification Date	Update	Recertification	9/11/2018 7:31:44 AM	8/21/2019 8:46:35 PM	8/21/2019 8:46 PM
Contacts	Authorizing Official	Update	Change Request	Mehta, Raj CFO/Vice President of Finance Niagara falls memorial medical center 7162784399	Wright, Mark Senior Vice President/Finance Niagara Falls Memorial Medical Center 7162784399	8/7/2019 10:32 AM
Contacts	Primary Contact	Update	Recertification	Lewis, Michelle Director of Pharmacy niagara falls memorial medical center 7162784357	Greer, Tristan 340B Coordinator Niagara Falls Memorial Medical Center 7162784537	9/11/2018 7:31 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 7:45:53 AM	9/11/2018 7:31:44 AM	9/11/2018 7:31 AM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	11/7/2017 7:45:53 AM	11/7/2017 7:45 AM
Contacts	Primary Contact	Update	Recertification	Lewis, Michelle Director of Pharmacy 7162784399	Lewis, Michelle Director of Pharmacy niagara falls memorial medical center 7162784357	10/25/2017 2:45 PM
Contacts	Authorizing Official	Update		Mehta, Raj CFO/Vice President of Finance 7162784399	Mehta, Raj CFO/Vice President of Finance Niagara falls memorial medical center 7162784399	9/28/2017 8:24 AM
Contacts	Authorizing Official	Update		FRAUENHOFER, CHRIS D. VP & CFO 7162784399	Mehta, Raj CFO/Vice President of Finance 7162784399	8/14/2017 10:52 AM
Contacts	Primary Contact	Insert			Lewis, Michelle Director of Pharmacy 7162784399	8/26/2016 3:36 PM
Addresses	Main Address	Insert			7751 PORTER ROAD NIAGARA FALLS, NY 14304	8/26/2016 3:36 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/26/2016 12:00:00 AM	8/26/2016 3:36 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/19/2015 9:28 AM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 9:28 AM
Details	Last Recertification Date	Update		9/5/2013 12:00:00 AM	9/3/2014 12:00:00 AM	9/3/2014 1:31 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 12:00:00 AM	9/5/2013 10:03 AM
Medicaid Billing	NPI: Number	Insert			1285717298	5/29/2012 2:38 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/29/2012 2:38 PM
Contacts	Authorizing Official	Insert			FRAUENHOFER, CHRIS D. VP & CFO 7162784399	1/25/2008 8:25 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	6/13/2007 2:39 PM
Medicaid Billing	Medicaid: Number	Insert			00354467	6/13/2007 2:39 PM
Medicaid Billing	Medicaid: State	Insert			NY	6/13/2007 2:39 PM
Details	Last Recertification Date	Insert				6/13/2007 2:39 PM
Details	Grant Number	Insert				6/13/2007 2:39 PM
Details	340B ID	Insert			DSH330065C	6/13/2007 2:39 PM
Details	Is Authorizing Official EHB Data	Insert				6/13/2007 2:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/13/2007 2:39 PM
Details	Medicare Provider Number	Insert			330065	6/13/2007 2:39 PM
Details	Entity Name	Insert			NIAGARA FALLS MEMORIAL MEDICAL CENTER	6/13/2007 2:39 PM
Details	Program Code	Insert			DSH	6/13/2007 2:39 PM
Details	Entity Subname	Insert			PORTER ROAD LABORATORY DRAW STATION	6/13/2007 2:39 PM
Dates	Participating Approval Date	Insert			6/14/2007 12:00:00 AM	6/13/2007 2:39 PM
Details	State	Insert			Active	6/13/2007 2:39 PM
Dates	Registration Date	Insert			6/13/2007 12:00:00 AM	6/13/2007 2:39 PM
Dates	Signed By Date	Insert			6/12/2007 12:00:00 AM	6/13/2007 2:39 PM
Dates	Start Date	Insert			7/1/2007 12:00:00 AM	6/13/2007 2:39 PM
Terminations	Termination Comments	Insert				6/13/2007 2:39 PM
Terminations	Termination Date	Insert				6/13/2007 2:39 PM
Terminations	Termination Effective Date	Insert				6/13/2007 2:39 PM
Terminations	Termination Reason	Insert				6/13/2007 2:39 PM