Covered Entity Details

DSH310119 UH - UNIVERSITY HOSPITAL (Active) - information as of 6/7/2025 6:06:33 AM

Main Details

Name

UH - UNIVERSITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310119

Medicare Provider Number

310119

Additional Details

Current Program Status

Active

Registration Date

8/29/2007

Participating Start Date

1/1/1999

Participating Approval Date

8/29/2007

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

University Hospital
Gary Huck, CFO
(973) 972-0882

Primary Contact

University Hospital
Mitch G Sobel, Director of Pharmaceutical Services
(973) 972-6258

Addresses

Street Address

150 BERGEN ST
NEWARK, NJ 07103

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
MD	373555900	1215998323
CT	3051703	1215998323
SC	10153A	1215998323
FL	905976800	1215998323
GA	000335497X	1215998323
NJ	0937835,3677001	1215998323,1306596390

Shipping Addresses

Shipping Address 1

University Hospital
150 Bergen Street
Newark, NJ 07103

Shipping Address 2

University Hospital Pharmacy
140 Bergen Street
Suite 1650
Newark, NJ 07103

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BERGEN PHARMACY	90 BERGEN ST STE 1600		NEWARK	NJ	07103	01/08/2015	04/01/2015		03/03/2017
Contract Detail	BERGEN PHARMACY	240 WILLIAMSON ST	STE 101	ELIZABETH	NJ	07202	01/08/2015	04/01/2015		03/03/2017
Contract Detail	LIVINGSTON INFUSION CARE INC	RWJBARNABAS HEALTH INFUSION AND SPECIALT	603 MONTROSE AVE	SOUTH PLAINFIELD	NJ	07080	10/13/2015	01/01/2016	10/07/2019	10/18/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH310119AA	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Gastroenterology	90 Bergen Street	Newark	NJ	Active
DSH310119AB	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Endocrinology	90 Bergen Street	Newark	NJ	Active
DSH310119AC	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Diabetes	90 Bergen Street	Newark	NJ	Active
DSH310119AD	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS Dermatology	140 Bergen Street	Newark	NJ	Active
DSH310119AE	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - PMR- Physiatry	90 Bergen Street	Newark	NJ	Active
DSH310119AF	Child	DSH	UH - UNIVERSITY HOSPITAL	Liver Transplant Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119AG	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Wellness Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119AH	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Cardiology (90 Bergen) - Cardiology	90 Bergen Street	Newark	NJ	Active
DSH310119AJ	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS Nephrology (90 Bergen) - Nephrology	90 Bergen Street	Newark	NJ	Active
DSH310119AK	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS - Hepatology (90 Bergen) - Hepatology	90 Bergen Street	Newark	NJ	Active
DSH310119AL	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - Adult Allergy/Immunology	90 Bergen Street	Newark	NJ	Active
DSH310119AM	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC Pediatric/Adolescence Clinic - Pediatric and Adolescent	90 Bergen Street	Newark	NJ	Active
DSH310119AN	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC Othopaedic Clinic - Orthopaedics	140 Bergen Street	Newark	NJ	Active
DSH310119B	Child	DSH	University Hospital	Cancer Center	205 South Orange Ave.	Newark	NJ	Terminated
DSH310119C	Child	DSH	UH - UNIVERSITY HOSPITAL	Opthalmology Serv/DOC Clinic	90 Bergen St.	Newark	NJ	Active
DSH310119D	Child	DSH	University Hospital	ACC - OBGYN	150 Bergen Street	Newark	NJ	Terminated
DSH310119E	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Infectious Disease	140 Bergen Street	Newark	NJ	Active
DSH310119F	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - OBGYN	140 Bergen Street	Newark	NJ	Active
DSH310119G	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Podiatry	140 Bergen Street	Newark	NJ	Active
DSH310119H	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Medical Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119J	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Neuro Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119K	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Pediatrics	140 Bergen Street	Newark	NJ	Terminated
DSH310119L	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Surgical Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119M	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - ENT Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119N	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Urology Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119P	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - SDS	90 Bergen Street	Newark	NJ	Active
DSH310119Q	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - Imaging	90 Bergen Street	Newark	NJ	Active
DSH310119R	Child	DSH	UH - UNIVERSITY HOSPITAL	UNIVERSITY HOSPITAL / CC - Radiation Oncology	205 South Orange Ave.	NEWARK	NJ	Active
DSH310119S	Child	DSH	UH - UNIVERSITY HOSPITAL	UNIVERSITY HOSPITAL / CC - Hematology/Oncology	205 South Orange Ave.	NEWARK	NJ	Active
DSH310119T	Child	DSH	UH - UNIVERSITY HOSPITAL	UNIVERSITY HOSPITAL / CC - Infusion	205 South Orange Ave.	NEWARK	NJ	Active
DSH310119U	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Cardiology	140 Bergen Street	Newark	NJ	Active
DSH310119V	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Neurosurgery	140 Bergen Street	Newark	NJ	Active
DSH310119W	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Rheumatology	90 Bergen Street	Newark	NJ	Active
DSH310119X	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Pulmonology	90 Bergen Street	Newark	NJ	Active
DSH310119Y	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS Nephrology	140 Bergen Street	Newark	NJ	Active
DSH310119Z	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS - Hepatology	140 Bergen Street	Newark	NJ	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/25/2024 4:41 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0937835	10/25/2024 4:41 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	10/25/2024 4:41 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1306596390	10/25/2024 4:41 PM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	10/25/2024 4:41 PM
Details	Last Recertification Date	Update	Recertification	8/29/2023 8:00:26 AM	8/27/2024 8:19:46 AM	8/27/2024 8:19 AM
Details	Last Recertification Date	Update	Recertification	8/30/2022 7:43:23 PM	8/29/2023 8:00:26 AM	8/29/2023 8:00 AM
Contacts	Primary Contact	Update	Change Request	EMONT, ANDRE PHARMACIST IN CHARGE University Hospital 9739726258	Sobel, Mitch G Director of Pharmaceutical Services University Hospital 9739726258	1/10/2023 7:49 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 10:34:49 AM	8/30/2022 7:43:23 PM	8/30/2022 7:43 PM
Contacts	Authorizing Official	Update	Profile Change Request	Huck, Gary Director, Reimbursement and Managed Care University Hospital 9739720882	Huck, Gary CFO University Hospital 9739720882	8/22/2022 7:01 AM
Addresses	Shipping Address	Insert	Change Request		University Hospital 150 Bergen Street Newark, NJ 07103	4/21/2022 3:03 PM
Addresses	Shipping Address	Insert	Change Request		University Hospital Pharmacy 140 Bergen Street Suite 1650 Newark, NJ 07103	4/21/2022 3:03 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 2:22:35 PM	8/19/2021 10:34:49 AM	8/19/2021 10:34 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007310620019 (PA)		6/18/2021 5:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10153A	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		905976800	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000335497X	6/18/2021 5:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	6/18/2021 5:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1215998323 (PA)		6/18/2021 5:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1215998323	6/18/2021 5:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		SC	6/18/2021 5:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1215998323	6/18/2021 5:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	6/18/2021 5:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1215998323	6/18/2021 5:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	6/18/2021 5:48 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1215998323 ( )		9/8/2020 2:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/8/2020 2:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/8/2020 2:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/8/2020 2:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/8/2020 2:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/8/2020 2:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/8/2020 2:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/8/2020 2:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/8/2020 2:22 PM
Details	Last Recertification Date	Update	Recertification	9/10/2019 12:38:55 PM	9/8/2020 2:22:35 PM	9/8/2020 2:22 PM
Contacts	Authorizing Official	Update	AO Change Request	Daly, Thomas VP & CFO University Hospital 9739723721	Huck, Gary Director, Reimbursement and Managed Care University Hospital 9739720882	12/16/2019 10:56 AM
Details	Last Recertification Date	Update	Recertification	9/7/2018 12:12:55 PM	9/10/2019 12:38:55 PM	9/10/2019 12:38 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	00362161 (NY)		3/18/2019 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007310620019	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		373555900	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00362161	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3051703	1/18/2019 2:47 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	1/18/2019 2:47 PM
Details	Last Recertification Date	Update	Recertification	11/20/2017 11:32:27 AM	9/7/2018 12:12:55 PM	9/7/2018 12:12 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/20/2017 11:32:27 AM	11/20/2017 11:32 AM
Contacts	Primary Contact	Update	Profile Change Request	EMONT, ANDY PHARMACIST IN CHARGE University Hospital 9739726258	EMONT, ANDRE PHARMACIST IN CHARGE University Hospital 9739726258	11/7/2017 11:26 AM
Contacts	Primary Contact	Update	Profile Change Request	EMONT, ANDY PHARMACIST IN CHARGE University Hospital 9739726953	EMONT, ANDY PHARMACIST IN CHARGE University Hospital 9739726258	11/7/2017 11:25 AM
Contacts	Primary Contact	Update		EMONT, ANDY PHARMACIST IN CHARGE 9739726953	EMONT, ANDY PHARMACIST IN CHARGE University Hospital 9739726953	11/6/2017 3:06 PM
Contacts	Authorizing Official	Update		Daly, Thomas VP & CFO 9739723721	Daly, Thomas VP & CFO University Hospital 9739723721	10/18/2017 4:20 PM
Contacts	Authorizing Official	Insert			Daly, Thomas VP & CFO 9739723721	3/3/2017 4:46 PM
Addresses	Main Address	Insert			150 BERGEN ST NEWARK, NJ 07103	3/3/2017 4:46 PM
Contacts	Primary Contact	Insert			EMONT, ANDY PHARMACIST IN CHARGE 9739726953	3/3/2017 4:46 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 12:33 PM
Details	Entity Name	Update		University Hospital	UH - UNIVERSITY HOSPITAL	8/3/2016 11:08 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/19/2015 3:55 PM
Details	Last Recertification Date	Update		8/19/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 3:55 PM
Details	Last Recertification Date	Update		8/22/2013 12:00:00 AM	8/19/2014 12:00:00 AM	8/19/2014 11:42 AM
Details	Entity Name	Update		UNIVERSITY HOSPITAL	University Hospital	7/23/2014 3:02 PM
Details	Entity Name	Update		UMDNJ UNIVERSITY HOSPITAL	UNIVERSITY HOSPITAL	11/25/2013 8:34 AM
Medicaid Billing	NPI: Number	Insert			1215998323	8/22/2013 5:30 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/22/2013 12:00:00 AM	8/22/2013 5:30 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/28/2012 4:03 PM
Details	Last Recertification Date	Insert				8/29/2007 10:32 AM
Details	Grant Number	Insert				8/29/2007 10:32 AM
Details	340B ID	Insert			DSH310119	8/29/2007 10:32 AM
Details	Is Authorizing Official EHB Data	Insert				8/29/2007 10:32 AM
Dates	Last Date That 340B Drugs Purchased	Insert				8/29/2007 10:32 AM
Details	Medicare Provider Number	Insert			310119	8/29/2007 10:32 AM
Details	Entity Name	Insert			UMDNJ UNIVERSITY HOSPITAL	8/29/2007 10:32 AM
Details	Program Code	Insert			DSH	8/29/2007 10:32 AM
Details	Entity Subname	Insert				8/29/2007 10:32 AM
Dates	Participating Approval Date	Insert			8/29/2007 12:00:00 AM	8/29/2007 10:32 AM
Details	State	Insert			Active	8/29/2007 10:32 AM
Dates	Registration Date	Insert			8/29/2007 12:00:00 AM	8/29/2007 10:32 AM
Dates	Signed By Date	Insert				8/29/2007 10:32 AM
Dates	Start Date	Insert			1/1/1999 12:00:00 AM	8/29/2007 10:32 AM
Terminations	Termination Comments	Insert				8/29/2007 10:32 AM
Terminations	Termination Date	Insert				8/29/2007 10:32 AM
Terminations	Termination Effective Date	Insert				8/29/2007 10:32 AM
Terminations	Termination Reason	Insert				8/29/2007 10:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	8/29/2007 10:31 AM
Medicaid Billing	Medicaid: Number	Insert			3677001	8/29/2007 10:31 AM
Medicaid Billing	Medicaid: State	Insert			NJ	8/29/2007 10:31 AM