Covered Entity Details

DSH330234 WESTCHESTER MEDICAL CENTER (Active) - information as of 5/23/2025 12:00:13 AM

Main Details

Name

WESTCHESTER MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330234

Medicare Provider Number

330234

Additional Details

Current Program Status

Active

Registration Date

9/14/2007

Participating Start Date

1/1/1994

Participating Approval Date

9/14/2007

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Westchester Medical Center
Anthony Costello, COO
(914) 493-7028

Primary Contact

Westchester Medical Center
Varghese Thankachen, Network Director of Pharmacy Business Operations
(914) 493-7205

Addresses

Street Address

100 Woods Road
Valhalla, NY 10595

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
5/7/08-UPDATED ADDRESS (WAS GRASSLANDS RESERVATION);12/23/10 ENTITY NAME WAS(WESTCHESTER COUNTY MEDICAL),UPDATED ADDR. WAS(95 GRASSLANDS ROAD)	12/23/2010

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
CT	003108992	1932280666
NJ	4159608	1932280666
NY	00274213	1932280666

Shipping Addresses

Shipping Address 1

Westchester Medical Center
100 Woods Road
Valhalla, NY 10595

Shipping Address 2

Westchester Medical Center
100 Woods Road
Specialty Pharmacy Suite 1A02
Valhalla, NY 10595

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/14/2020	01/01/2021		01/01/2021
Contract Detail	DUANE READE	678 MCLEAN AVENUE		YONKERS	NY	10704	10/14/2020	01/01/2021	04/12/2023	04/14/2023
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO INC	DBA: WALGREENS #09866	370 WHITE PLAINS RD.	EASTCHESTER	NY	10709-2804	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO INC	DBA: WALGREENS # 02122	1230 NEPPERHAN AVE	YONKERS	NY	10703	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO INC	DBA: WALGREENS #09972	1046 YONKERS AVE.	YONKERS	NY	10704-3038	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO. INC	DBA: WALGREENS #15590	95 LOCUST AVENUE SUITE 100	DANBURY	CT	06810	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO. INC.	DBA WALGREENS	411 KING ST.	CHAPPAQUA	NY	10514	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO. INC.	DBA WALGREENS	11 ASHFORD AVE.	DOBBS FERRY	NY	10522	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06650	201 PLAZA ROAD	KINGSTON	NY	12401	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	82 N. PLANK RD.	NEWBURGH	NY	12550	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	416 WINDSOR HWY	VAILS GATE	NY	12584	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	827 DUTCHESS TURNPIKE	POUGHKEEPSIE	NY	12603-2059	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	704 FREEDOM PLAINS RD. SUITE A1	POUGHKEEPSIE	NY	12603	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	6 MCLEAN AVE	YONKERS	NY	10705-2356	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2084 STATE ROUTE 208	MONTGOMERY	NY	12549	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	35 KENSICO RD.	THORNWOOD	NY	10594	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	31 CAVALRY DR.	NEW CITY	NY	10956	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07932	2024 SOUTH RD	POUGHKEEPSIE	NY	12601-5954	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	16 ROUTE 59	NYACK	NY	10960	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02758	162 WILDEY ST	TARRYTOWN	NY	10591-2902	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16078	205 8TH AVENUE	NEW YORK	NY	10011	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #07485	107 N. MAIN ST.	PORT CHESTER	NY	10573-4210	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	870 CENTRAL PARK AVE.	SCARSDALE	NY	10583	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: COMMUNITY, A WALGREENS PHARMACY #2	66 E. POST RD 1ST FLOOR	WHITE PLAINS	NY	10601	10/14/2020	01/01/2021	09/03/2024	10/01/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1575 ROUTE 9	WAPPINGERS FALLS	NY	12590-4910	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	208 E. ROUTE 59	SPRING VALLEY	NY	10977	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10446	135 S. LIBERTY DR.	STONY POINT	NY	10980-2422	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	78 CROTON AVE.	OSSINING	NY	10562	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04029	209 ROUTE 59	SUFFERN	NY	10901	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15313	19 BRADHURST AVENUE SUITE L1	HAWTHORNE	NY	10532	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1201 MAIN ST.	PEEKSKILL	NY	10566	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY #21248	100 WOODS RD STE A1-105	VALHALLA	NY	10595	02/02/2021	02/16/2021		02/16/2021
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/14/2020	01/01/2021		01/01/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330234A	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Hematotherapy Clinic -Blood Storing, Processing & Transfusion	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234AA	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Turning Point	241 North Road	Poughkeepsie	NY	Terminated
DSH330234AB	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Recovery Room	241 North Road	Poughkeepsie	NY	Active
DSH330234AD	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Radiology	241 North Road	Poughkeepsie	NY	Active
DSH330234AE	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: RadioIsotopes	241 North Road	Poughkeepsie	NY	Terminated
DSH330234AF	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Respiratory Therapy	241 North Road	Poughkeepsie	NY	Active
DSH330234AG	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Ultrasound	241 North Road	Poughkeepsie	NY	Active
DSH330234AH	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Woundcare/Hyperbaric	1 Webster Avenue	Poughkeepsie	NY	Active
DSH330234AJ	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital - Observation Beds	241 North Road	Poughkeepsie	NY	Active
DSH330234AK	Child	DSH	WESTCHESTER MEDICAL CENTER	DENTISTRY CLINIC - MACY PAVILION	100 Woods Road	VALHALLA	NY	Terminated
DSH330234AL	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Ophthalmology Clinic SUITE 600	19 Bradhurst	Hawthorne	NY	Active
DSH330234AM	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Children's Clinic - Pediatric - Suite #550	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234AN	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Cancer Center - Outpatient Infusion Center	19 Bradhurst Avenue	Hawthorne	NY	Active
DSH330234AP	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC HEART AND VASCULAR IMAGING CENTER - RADIOLOGY - IMAGING	19 BRADHURST AVE	Hawthorne	NY	Terminated
DSH330234B	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Pulmonary Function Testing	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234C	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Adult Clinic - Suite #700	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234D	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: HIV-AIDS Ally Clinic - Suite #600	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234E	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Behavioral Health Center: Mental Health Clinic	20 HOSPITAL ROAD	Valhalla	NY	Active
DSH330234F	Child	DSH	WESTCHESTER MEDICAL CENTER	Referred Ambulatory Services	19 BRADHURST AVE	HAWTHORNE	NY	Terminated
DSH330234G	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Advanced Imaging - Suite 1000	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234H	Child	DSH	WESTCHESTER MEDICAL CENTER	Speech Pathology	19 Bradhurst Ave.	Hawthorne	NY	Terminated
DSH330234K	Child	DSH	Westchester Medical Center	MidHudson Regional Hospital: 6 Cooke	241 North Road	Poughkeepsie	NY	Terminated
DSH330234L	Child	DSH	Westchester Medical Center	MidHudson Regional Hospital: Alcohol Rehab	241 North Road	Poughkeepsie	NY	Terminated
DSH330234M	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Atrium Surgery Center	1 Webster Avenue	Poughkeepsie	NY	Active
DSH330234N	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Cardiac Cath Lab	241 North Road	Poughkeepsie	NY	Active
DSH330234P	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Cardiology	241 North Road	Poughkeepsie	NY	Active
DSH330234R	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Clinic	1 Webster Avenue	Poughkeepsie	NY	Terminated
DSH330234S	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: CT Scan	241 North Road	Poughkeepsie	NY	Active
DSH330234T	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Interventional Radiology	241 North Road	Poughkeepsie	NY	Active
DSH330234U	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: EEG	241 North Road	Poughkeepsie	NY	Active
DSH330234V	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Emergency Dept	241 North Road	Poughkeepsie	NY	Active
DSH330234W	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Wellness Center	241 North Road	Poughkeepsie	NY	Terminated
DSH330234Y	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Infusion Center	19 Baker Avenue	Poughkeepsie	NY	Active
DSH330234Z	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Operating Room	241 North Road	Poughkeepsie	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Change Request		Westchester Medical Center 100 Woods Road Valhalla, NY 10595	5/19/2025 11:42 AM
Addresses	Shipping Address	Insert	Change Request		Westchester Medical Center 100 Woods Road Specialty Pharmacy Suite 1A02 Valhalla, NY 10595	5/19/2025 11:42 AM
Details	Last Recertification Date	Update	Recertification	9/1/2023 1:05:37 PM	9/3/2024 9:01:23 AM	9/3/2024 9:01 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 7:30:31 AM	9/1/2023 1:05:37 PM	9/1/2023 1:05 PM
Contacts	Primary Contact	Update	Profile Change Request	Thankachen, Varghese Director of Pharmacy Westchester Medical Center 9144937205	Thankachen, Varghese Network Director of Pharmacy Business Operations Westchester Medical Center 9144937205	7/13/2023 9:45 AM
Details	Last Recertification Date	Update	Recertification	9/14/2021 2:39:35 PM	9/14/2022 7:30:31 AM	9/14/2022 7:30 AM
Details	Last Recertification Date	Update	Recertification	9/14/2020 6:59:39 AM	9/14/2021 2:39:35 PM	9/14/2021 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:59 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003108992	9/14/2020 6:59 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/14/2020 6:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:59 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4159608	9/14/2020 6:59 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/14/2020 6:59 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/14/2020 6:59 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/14/2020 6:59 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/14/2020 6:59 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/14/2020 6:59 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/14/2020 6:59 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/14/2020 6:59 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1932280666 ( )		9/14/2020 6:59 AM
Details	Last Recertification Date	Update	Recertification	9/15/2019 8:50:14 AM	9/14/2020 6:59:39 AM	9/14/2020 6:59 AM
Contacts	Authorizing Official	Update	Change Request	Esses, Allen Chief Supply Chain Officer Westchester Medical Center 9144936543	Costello, Anthony COO Westchester Medical Center 9144937028	3/6/2020 12:35 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 1:04:16 PM	9/15/2019 8:50:14 AM	9/15/2019 8:50 AM
Details	Last Recertification Date	Update	Recertification	12/4/2017 1:30:59 PM	8/28/2018 1:04:16 PM	8/28/2018 1:04 PM
Contacts	Primary Contact	Update	Recertification	County, Anthony Pharmacy Project Lead 9144937102	Thankachen, Varghese Director of Pharmacy Westchester Medical Center 9144937205	12/4/2017 1:30 PM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	12/4/2017 1:30:59 PM	12/4/2017 1:30 PM
Contacts	Authorizing Official	Update	AO Change Request	ISRAEL, MICHAEL CEO 9144937017	Esses, Allen Chief Supply Chain Officer Westchester Medical Center 9144936543	11/29/2017 10:57 AM
Contacts	Primary Contact	Insert			County, Anthony Pharmacy Project Lead 9144937102	8/16/2016 5:12 PM
Addresses	Main Address	Insert			100 WOODS ROAD VALHALLA, NY 10595	8/12/2016 10:24 AM
Details	Last Recertification Date	Update		9/4/2015 12:00:00 AM	8/12/2016 12:00:00 AM	8/12/2016 10:24 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	9/4/2015 2:40 PM
Details	Last Recertification Date	Update		9/10/2014 12:00:00 AM	9/4/2015 12:00:00 AM	9/4/2015 2:40 PM
Details	Last Recertification Date	Update		9/13/2013 12:00:00 AM	9/10/2014 12:00:00 AM	9/10/2014 6:56 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/13/2013 12:00:00 AM	9/13/2013 11:25 AM
Medicaid Billing	NPI: Number	Insert			1932280666	5/16/2012 8:13 AM
Contacts	Authorizing Official	Insert			ISRAEL, MICHAEL CEO 9144937017	5/16/2012 8:13 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/16/2012 8:13 AM
Details	Last Recertification Date	Insert				12/23/2010 12:04 PM
Details	Grant Number	Insert				12/23/2010 12:04 PM
Details	340B ID	Insert			DSH330234	12/23/2010 12:04 PM
Details	Is Authorizing Official EHB Data	Insert				12/23/2010 12:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/23/2010 12:04 PM
Details	Medicare Provider Number	Insert			330234	12/23/2010 12:04 PM
Details	Entity Name	Insert			WESTCHESTER MEDICAL CENTER	12/23/2010 12:04 PM
Details	Program Code	Insert			DSH	12/23/2010 12:04 PM
Details	Entity Subname	Insert				12/23/2010 12:04 PM
Dates	Participating Approval Date	Insert			9/14/2007 12:00:00 AM	12/23/2010 12:04 PM
Details	State	Insert			Active	12/23/2010 12:04 PM
Dates	Registration Date	Insert			9/14/2007 12:00:00 AM	12/23/2010 12:04 PM
Dates	Signed By Date	Insert				12/23/2010 12:04 PM
Dates	Start Date	Insert			1/1/1994 12:00:00 AM	12/23/2010 12:04 PM
Terminations	Termination Comments	Insert				12/23/2010 12:04 PM
Terminations	Termination Date	Insert				12/23/2010 12:04 PM
Terminations	Termination Effective Date	Insert				12/23/2010 12:04 PM
Terminations	Termination Reason	Insert				12/23/2010 12:04 PM
Details	Comments Public	Insert			5/7/08-UPDATED ADDRESS (WAS GRASSLANDS RESERVATION);12/23/10 ENTITY NAME WAS(WESTCHESTER COUNTY MEDICAL),UPDATED ADDR. WAS(95 GRASSLANDS ROAD)	12/23/2010 12:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/14/2007 6:18 PM
Medicaid Billing	Medicaid: Number	Insert			00274213	9/14/2007 6:18 PM
Medicaid Billing	Medicaid: State	Insert			NY	9/14/2007 6:18 PM