Covered Entity Details

DSH080004L BAYHEALTH MEDICAL CENTER INC. (Active) - information as of 6/23/2025 12:34:16 AM

Main Details

Name

BAYHEALTH MEDICAL CENTER INC.

Subdivision Name

Outpatient Center, Imaging,Governors Avenue, Kent Campus

Type

Disproportionate Share Hospital

Rural

340B ID

DSH080004L

Medicare Provider Number

080004

Outpatient Facility Provider Number

080004

Additional Details

Current Program Status

Active

Registration Date

2/23/2012

Participating Start Date

4/1/2012

Participating Approval Date

3/26/2012

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Bayhealth Medical Center
Michael James Tretina, CFO
(302) 744-7162

Primary Contact

Bayhealth Medical Center
Cheri Briggs, Senior Director, Pharmacy
(302) 744-7020

Addresses

Street Address

540 S. Governors Avenue
Suite 101B
Dover, DE 19904-3530

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?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH080004A	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	KENT GENERAL HOSPITAL HOME HEALTH	560 South Governors Ave.	DOVER	DE	Terminated
DSH080004B	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	KENT GENERAL HOSPITAL OUTPATIENT REHAB.	560 SOUTH GOVERNORS AVENUE	DOVER	DE	Terminated
DSH080004C	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	Womens Center, Kent Campus	540 SOUTH GOVERNORS AVENUE	DOVER	DE	Active
DSH080004D	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	KENT GENERAL HOSPITAL CANCER CENTER	640 South State Street	Dover	DE	Terminated
DSH080004E	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	KENT GENERAL HOSPITAL MIDDLETOWN OP SERVICE CENTER	209 EAST MAIN STREET	MIDDLETOWN	DE	Terminated
DSH080004F	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	KENT GENERAL HOSPITAL SMYRNA CLAYTON MEDICAL SERVICES	401 North Carter Road	SMYRNA	DE	Terminated
DSH080004G	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	KENT GENERAL HOSPITAL RENAL DIALYSIS	640 SOUTH STATE STREET	DOVER	DE	Terminated
DSH080004H	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	Kent General Hospital Outpatient Imaging at Eden Hill	200 Banning Street	Dover	DE	Terminated
DSH080004J	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	Cardiac Diagnostics, Bayhealth Kent Campus Hospital	540 S. Governors Avenue, Kent Campus Hospital	Dover	DE	Active
DSH080004K	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	Kent General Hospital Bayhealth Pain Treatment Center	826 South Governors Avenue	Dover	DE	Terminated
DSH080004L	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	Outpatient Center, Imaging,Governors Avenue, Kent Campus	540 S. Governors Avenue	Dover	DE	Active
DSH080004M	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	Bayhealth Kent Campus Hospital, Emergency Center, Smyrna	401 N. Carter Road, Suite 101	Smyrna	DE	Active
DSH080004N	Child	DSH	BAYHEALTH MEDICAL CENTER INC.	Surgery Center, Kent - Bayhealth Surgery Center, Kent Campus	100 Scull Terrace	Dover	DE	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 3:26:11 PM	8/22/2024 1:46:10 PM	8/22/2024 1:46 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 1:52:57 PM	8/21/2023 3:26:11 PM	8/21/2023 3:26 PM
Details	Last Recertification Date	Update	Recertification	8/27/2021 12:52:02 PM	9/1/2022 1:52:57 PM	9/1/2022 1:52 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 2:37:12 PM	8/27/2021 12:52:02 PM	8/27/2021 12:52 PM
Contacts	Primary Contact	Update	Recertification	Zarow, Alex Pharmacy Director Bayhealth Medical Center 3027446753	Briggs, Cheri Senior Director, Pharmacy Bayhealth Medical Center 3027447020	9/4/2020 2:37 PM
Details	Last Recertification Date	Update	Recertification	8/26/2019 9:45:13 AM	9/4/2020 2:37:12 PM	9/4/2020 2:37 PM
Contacts	Authorizing Official	Update	New Registration	Tretina, Michael CFO Bayhealth Medical Center 3027447162	Tretina, Michael James CFO Bayhealth Medical Center 3027447162	1/3/2020 10:13 AM
Details	Entity Subname	Update	Change Request	Outpatient Center, IManaging,Governors Avenue, Kent Campus	Outpatient Center, Imaging,Governors Avenue, Kent Campus	11/14/2019 2:32 PM
Addresses	Main Address	Update	Recertification	540 S. Governors Avenue Dover, DE 19904-3530	540 S. Governors Avenue Suite 101B Dover, DE 19904-3530	8/26/2019 9:45 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 10:31:32 AM	8/26/2019 9:45:13 AM	8/26/2019 9:45 AM
Details	Entity Subname	Update	Recertification	Kent General Hospital Dover Outpatient Imaging Center	Outpatient Center, IManaging,Governors Avenue, Kent Campus	8/26/2019 9:45 AM
Details	Last Recertification Date	Update	Recertification	11/14/2017 2:24:30 PM	8/21/2018 10:31:32 AM	8/21/2018 10:31 AM
Details	Last Recertification Date	Update	Recertification	8/30/2016 12:00:00 AM	11/14/2017 2:24:30 PM	11/14/2017 2:24 PM
Contacts	Primary Contact	Update	Recertification	Zarow, Alex Pharmacy Director 3027446753	Zarow, Alex Pharmacy Director Bayhealth Medical Center 3027446753	11/14/2017 2:23 PM
Contacts	Authorizing Official	Update		Tretina, Michael CFO 3027447162	Tretina, Michael CFO Bayhealth Medical Center 3027447162	10/30/2017 10:15 AM
Contacts	Authorizing Official	Insert			Tretina, Michael CFO 3027447162	3/20/2017 4:48 PM
Addresses	Main Address	Insert			540 S. Governors Avenue Dover, DE 19904-3530	8/30/2016 1:15 PM
Contacts	Primary Contact	Insert			Zarow, Alex Pharmacy Director 3027446753	8/30/2016 1:15 PM
Contacts	Signed By	Insert			Tanis, Earl P. CFO 3027447162	8/30/2016 1:15 PM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/30/2016 12:00:00 AM	8/30/2016 1:15 PM
Details	Last Recertification Date	Update		9/8/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 2:10 PM
Details	Last Recertification Date	Update		9/9/2013 10:02:59 PM	9/8/2014 12:00:00 AM	9/8/2014 8:09 AM
Details	Last Recertification Date	Update			9/9/2013 10:02:59 PM	9/9/2013 10:02 PM
Details	340B ID	Update		IS-DR-DSH080004L	DSH080004L	3/26/2012 11:37 AM
Dates	Participating Approval Date	Update			3/26/2012 12:00:00 AM	3/26/2012 11:37 AM
Details	State	Update		Pending	Active	3/26/2012 11:37 AM
Dates	Start Date	Update			4/1/2012 12:00:00 AM	3/26/2012 11:37 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DR-DSH080004L	3/2/2012 4:09 PM
Details	Last Recertification Date	Insert				2/23/2012 10:07 AM
Details	Grant Number	Insert				2/23/2012 10:07 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	2/23/2012 10:07 AM
Details	Is Authorizing Official EHB Data	Insert				2/23/2012 10:07 AM
Dates	Last Date That 340B Drugs Purchased	Insert				2/23/2012 10:07 AM
Details	Medicare Provider Number	Insert			080004	2/23/2012 10:07 AM
Details	Entity Name	Insert			BAYHEALTH MEDICAL CENTER INC.	2/23/2012 10:07 AM
Details	Program Code	Insert			DSH	2/23/2012 10:07 AM
Details	Entity Subname	Insert			Kent General Hospital Dover Outpatient Imaging Center	2/23/2012 10:07 AM
Dates	Participating Approval Date	Insert				2/23/2012 10:07 AM
Details	State	Insert			Pending	2/23/2012 10:07 AM
Dates	Registration Date	Insert			2/23/2012 12:00:00 AM	2/23/2012 10:07 AM
Dates	Signed By Date	Insert			2/23/2012 12:00:00 AM	2/23/2012 10:07 AM
Dates	Start Date	Insert				2/23/2012 10:07 AM
Terminations	Termination Comments	Insert				2/23/2012 10:07 AM
Terminations	Termination Date	Insert				2/23/2012 10:07 AM
Terminations	Termination Effective Date	Insert				2/23/2012 10:07 AM
Terminations	Termination Reason	Insert				2/23/2012 10:07 AM