Covered Entity Details

DSH310092 CAPITAL HEALTH SYSTEM - FULD (Active) - information as of 6/28/2025 12:18:44 AM

Main Details

Name

CAPITAL HEALTH SYSTEM - FULD

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310092

Medicare Provider Number

310092

Additional Details

Current Program Status

Active

Registration Date

8/29/2007

Participating Start Date

10/1/2012

Participating Approval Date

9/27/2012

Last Recertification Date

9/16/2024

Contacts

Authorizing Official

Capital Health System., Inc.
Laura McGuire, CCO
(609) 394-6783

Primary Contact

Capital Health System, Inc.
Kenneth John Bevenour, Director of Pharmacy
(609) 815-7657

Addresses

Street Address

750 BRUNSWICK AVENUE
TRENTON, NJ 08638

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
9/27/12 participating 1/1/05 thru 6/30/2011, not participating 7/1/11 thru 9/30/12	09/27/2012

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
NJ	3676609	1275583726,1700836285,1568411940
CT	008017569	1275583726,1568411940,1700836285
AZ	429963	1275583726,1568411940,1700836285
DE	250544028	1275583726,1568411940,1700836285
GA	003199841A	1275583726,1568411940,1700836285
NC	1275583726	1275583726,1568411940,1700836285
OH	0238522	1275583726,1568411940,1700836285
PA	1007558880003,1007558880006,1007558880009	1275583726,1568411940,1700836285
SC	11894B	1275583726,1568411940,1700836285
WA	2134499	1275583726,1568411940,1700836285
NY	1275583726	1275583726,1568411940,1700836285
VA	30014967060005

Shipping Addresses

Shipping Address 1

CAPITAL HEALTH SYSTEM - FULD
750 BRUNSWICK AVENUE
TRENTON, NJ 08638

Shipping Address 2

CAPITAL HEALTH COMMUNITY PHARMACY
TWO CAPITAL WAY
PENNINGTON, NJ 08534

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BOSWELL PHARMACY SERVICES, LLC	131 SCHOOLHOUSE ROAD	P O BOX 266	JENNERSTOWN	PA	15547	01/17/2023	02/07/2023		02/07/2023
Contract Detail	EPISCOPOS PHARMACY	1125 CHAMBERS ST		TRENTON	NJ	08610-5801	01/14/2014	04/01/2014	12/10/2016	05/10/2017
Contract Detail	MEDICAL HOME PHARMACY	828 N. OLDEN AVE		TRENTON	NJ	08638	07/10/2015	10/01/2015	12/10/2016	05/10/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH310092B	Child	DSH	CAPITAL HEALTH SYSTEM - FULD	Health Start Clinic	433 Bellevue Ave	Trenton	NJ	Active
DSH310092C	Child	DSH	CAPITAL HEALTH SYSTEM - FULD	Family Health Center	433 Bellevue Ave	Trenton	NJ	Active
DSH310092D	Child	DSH	CAPITAL HEALTH SYSTEM - FULD	Pediatric Clinic	433 Bellevue Ave	Trenton	NJ	Active
DSH310092E	Child	DSH	CAPITAL HEALTH SYSTEM - FULD	Medical Clinic - Internal Medicine	601 Hamilton Avenue	Trenton	NJ	ToBeTerminated
DSH310092F	Child	DSH	CAPITAL HEALTH SYSTEM - FULD	CARES Program - CARES Program	601 Hamilton Avenue	Trenton	NJ	Terminated
DSH310092G	Child	DSH	CAPITAL HEALTH SYSTEM - FULD	Satellite Emergency Department - East Trenton - Emergency	601 Hamilton Avenue	Trenton	NJ	ToBeTerminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007558880006	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007558880009	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		30014967060005	4/24/2025 1:39 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		VA	4/24/2025 1:39 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1750156568 (NJ)		4/24/2025 1:39 PM
Details	Last Recertification Date	Update	Recertification	9/8/2023 1:00:34 PM	9/16/2024 2:42:40 PM	9/16/2024 2:42 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	312315 (NJ)		6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		008017569	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CT	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		429963	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		AZ	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		250544028	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		DE	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		003199841A	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		GA	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NC	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		0238522	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OH	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007558880003	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		11894B	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		SC	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		2134499	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WA	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NY	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275583726	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568411940	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1700836285	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	6/13/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1750156568	6/13/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	6/13/2024 4:36 PM
Addresses	Shipping Address	Insert	Change Request		CAPITAL HEALTH SYSTEM - FULD 750 BRUNSWICK AVENUE TRENTON, NJ 08638	4/10/2024 9:42 AM
Addresses	Shipping Address	Insert	Change Request		CAPITAL HEALTH COMMUNITY PHARMACY TWO CAPITAL WAY PENNINGTON, NJ 08534	4/10/2024 9:42 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 12:22:49 PM	9/8/2023 1:00:34 PM	9/8/2023 1:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/3/2023 11:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		312315	5/3/2023 11:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	5/3/2023 11:41 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1215050745 (NJ)		5/3/2023 11:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1700836285	5/3/2023 11:41 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	5/3/2023 11:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1568411940	5/3/2023 11:41 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	5/3/2023 11:41 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 8:27:17 AM	9/12/2022 12:22:49 PM	9/12/2022 12:22 PM
Contacts	Authorizing Official	Update	Change Request	Miller, Stephen A. CCO Capital Health System, Inc. 6093946783	McGuire, Laura CCO Capital Health System., Inc. 6093946783	8/16/2022 7:42 AM
Contacts	Primary Contact	Update	Change Request	Abazia, Daniel Director of Pharmacy Capital Health System, Inc. 6098157657	Bevenour, Kenneth John Director of Pharmacy Capital Health System, Inc. 6098157657	8/16/2022 7:42 AM
Details	Last Recertification Date	Update	Recertification	9/14/2020 3:49:52 PM	8/26/2021 8:27:17 AM	8/26/2021 8:27 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	310092 (NJ)		9/14/2020 3:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 3:49 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3676609	9/14/2020 3:49 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/14/2020 3:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275583726	9/14/2020 3:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/14/2020 3:49 PM
Medicaid Billing	NPI: State	Update	Recertification		NJ	9/14/2020 3:49 PM
Details	Last Recertification Date	Update	Recertification	8/22/2019 5:33:58 AM	9/14/2020 3:49:52 PM	9/14/2020 3:49 PM
Contacts	Primary Contact	Update	Change Request	Lau, Chester Director of Pharmacy Capital Health System 6093946079	Abazia, Daniel Director of Pharmacy Capital Health System, Inc. 6098157657	3/13/2020 10:45 AM
Details	Last Recertification Date	Update	Recertification	8/22/2018 2:03:43 PM	8/22/2019 5:33:58 AM	8/22/2019 5:33 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 9:53:58 PM	8/22/2018 2:03:43 PM	8/22/2018 2:03 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/15/2017 9:53:58 PM	11/15/2017 9:53 PM
Contacts	Primary Contact	Update		Lau, Chester Director of Pharmacy 6093946079	Lau, Chester Director of Pharmacy Capital Health System 6093946079	9/22/2017 8:14 AM
Contacts	Authorizing Official	Update		Miller, Stephen A. CCO 6093946783	Miller, Stephen A. CCO Capital Health System, Inc. 6093946783	9/21/2017 3:04 PM
Contacts	Signed By	Insert			Fleming, Shane CFO 6093946029	8/10/2017 11:13 AM
Contacts	Authorizing Official	Insert			Miller, Stephen A. CCO 6093946783	8/10/2017 11:13 AM
Contacts	Primary Contact	Insert			Lau, Chester Director of Pharmacy 6093946079	8/10/2017 11:13 AM
Addresses	Main Address	Insert			750 BRUNSWICK AVENUE TRENTON, NJ 08638	5/10/2017 5:25 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 3:16 PM
Medicaid Billing	NPI: Number	Insert			1215050745	7/8/2016 10:18 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/5/2015 5:16 PM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 5:16 PM
Details	Last Recertification Date	Update		9/11/2013 12:00:00 AM	9/5/2014 12:00:00 AM	9/5/2014 6:20 PM
Details	Last Recertification Date	Update			9/11/2013 12:00:00 AM	9/11/2013 12:45 PM
Dates	Participating Approval Date	Update			9/27/2012 12:00:00 AM	9/27/2012 5:30 PM
Details	State	Update		Pending	Active	9/27/2012 5:30 PM
Dates	Start Date	Update		1/1/2005 12:00:00 AM	10/1/2012 12:00:00 AM	9/27/2012 5:30 PM
Details	Comments Public	Insert			9/27/12 participating 1/1/05 thru 6/30/2011, not participating 7/1/11 thru 9/30/12	9/27/2012 5:30 PM
Dates	Participating Approval Date	Update		8/29/2007 12:00:00 AM		9/27/2012 4:07 PM
Details	State	Update		Terminated	Pending	9/27/2012 4:07 PM
Dates	Signed By Date	Update			8/23/2012 12:00:00 AM	9/27/2012 4:07 PM
Terminations	Termination Date	Update		7/1/2011 12:00:00 AM		9/27/2012 4:07 PM
Terminations	Termination Reason	Update		DSH percentage below statutory minimum		9/27/2012 4:07 PM
Details	Last Recertification Date	Insert				6/30/2011 10:20 PM
Details	Grant Number	Insert				6/30/2011 10:20 PM
Details	340B ID	Insert			DSH310092	6/30/2011 10:20 PM
Details	Is Authorizing Official EHB Data	Insert				6/30/2011 10:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/30/2011 10:20 PM
Details	Medicare Provider Number	Insert			310092	6/30/2011 10:20 PM
Details	Entity Name	Insert			CAPITAL HEALTH SYSTEM - FULD	6/30/2011 10:20 PM
Details	Program Code	Insert			DSH	6/30/2011 10:20 PM
Details	Entity Subname	Insert				6/30/2011 10:20 PM
Dates	Participating Approval Date	Insert			8/29/2007 12:00:00 AM	6/30/2011 10:20 PM
Details	State	Insert			Terminated	6/30/2011 10:20 PM
Dates	Registration Date	Insert			8/29/2007 12:00:00 AM	6/30/2011 10:20 PM
Dates	Signed By Date	Insert				6/30/2011 10:20 PM
Dates	Start Date	Insert			1/1/2005 12:00:00 AM	6/30/2011 10:20 PM
Terminations	Termination Comments	Insert				6/30/2011 10:20 PM
Terminations	Termination Date	Insert			7/1/2011 12:00:00 AM	6/30/2011 10:20 PM
Terminations	Termination Effective Date	Insert				6/30/2011 10:20 PM
Terminations	Termination Reason	Insert			DSH percentage below statutory minimum	6/30/2011 10:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	8/29/2007 8:57 AM
Medicaid Billing	Medicaid: Number	Insert			310092	8/29/2007 8:57 AM
Medicaid Billing	Medicaid: State	Insert			NJ	8/29/2007 8:57 AM