Covered Entity Details

DSH330101BX NEW YORK-PRESBYTERIAN HOSPITAL (Active) - information as of 4/23/2025 10:51:53 PM

Main Details

Name

NEW YORK-PRESBYTERIAN HOSPITAL

Subdivision Name

Comprehensive Health Program

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330101BX

Medicare Provider Number

330101

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

5/30/2012

Participating Start Date

7/1/2012

Participating Approval Date

6/28/2012

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

New York Presbyterian
William Farrell, SVP, Finance
(212) 297-4358

Primary Contact

NewYork-Presbyterian Hospital
Gajendra Gharia, Director of Finance, Dept of 340B Programs
(212) 297-4353

Addresses

Street Address

180 Ft. Washington Avenue
HP, 6th Floor and 3rd Floor
VC-3
New York, NY 10032

Billing Address

NewYork-Presbyterian Hospital
525 East 68th Street
New York, NY 10065

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	00243178	1194832477
NJ	4148509	1194832477

Shipping Addresses

Shipping Address 1

NewYork-Presbyterian Hospital
622 West 168th Street
VCB Main Pharmacy
New York, NY 10032

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
Contract Detail	27 AUDUBON PHARMACY CORP.	D/B/A QUICK RX	27 AUDUBON AVENUE	NEW YORK	NY	10032	11/30/2017	01/01/2018	01/01/2018	12/18/2017	01/02/2018
Contract Detail	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	11/30/2017	01/01/2018		04/01/2023	03/30/2024
Contract Detail	AIDS HEALTHCARE FOUNDATION	AHF PHARMACY	619 MAIN ST	FARMINGDALE	NY	11735-4100	12/01/2017	01/01/2018		04/01/2023	03/30/2024
Contract Detail	NEWYORK-PRESBYTERIAN / QUEENS	56-45 MAIN ST.		FLUSHING	NY	11355-5045	01/14/2019	04/01/2019		04/01/2023	03/30/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330101AA	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Audubon Family Planning Practice	21 Audubon Avenue	New York	NY	Active
DSH330101AD	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	John F. Kennedy High School Clinic	99 Terrace View Avenue	Bronx	NY	Active
DSH330101AE	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	ACN ALLEN HOSPITAL PRACTICE	5141 Broadway	New York	NY	Terminated
DSH330101AF	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	OPERATING ROOMS MILSTEIN 3 AND 4	177 Fort Washington Ave.	New York	NY	Active
DSH330101AG	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Comprehensive Cancer Center	161 Fort Washington Avenue	New York	NY	Active
DSH330101AH	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	EYE 4 AMBULATORY SURGERY UNIT	635 West 165th Street	New York	NY	Terminated
DSH330101AJ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	PERINATAL CLINIC	21 Audubon Avenue	New York	NY	Active
DSH330101AK	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Recovery Rooms-Milstein 3 and 4	177 Fort Washington Avenue	New York	NY	Active
DSH330101AL	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CYSTOSCOPY	173 Fort Washington Avenue	New York	NY	Active
DSH330101AM	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MILSTEIN EMERGENCY	630 West 168th Street	New York	NY	Active
DSH330101AN	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MILSTEIN EMERGENCY B	630 West 168th Street	New York	NY	Terminated
DSH330101AP	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MILSTEIN CARDIAC CATHETERIZATION LAB	177 Fort Washington Avenue	New York	NY	Active
DSH330101AQ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	VANDERBILT CLINIC CT SCAN	622 West 168th Street	New York	NY	Active
DSH330101AR	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	INTERVENTIONAL NEURORADIOLOGY	177 Fort Washington Avenue	New York	NY	Active
DSH330101AS	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NEUROLOGY ICU - CT SCAN	177 Fort Washington Avenue	New York	NY	Active
DSH330101AT	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MRI - PRESBYTERIAN HOSPITAL	622 West 168th Street	New York	NY	Active
DSH330101AU	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MRI - HIP	161 Fort Washington Avenue	New York	NY	Active
DSH330101AV	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	ULTRASOUND - MILSTEIN	177 Fort Washington Avenue	New York	NY	Active
DSH330101AW	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CT SCAN - MILSTEIN 4	177 Fort Washington Avenue	New York	NY	Active
DSH330101AX	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CT SCAN - HIP	161 Fort Washington Avenue	New York	NY	Active
DSH330101AY	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CT SCAN - BABIES	3959 Broadway	New York	NY	Active
DSH330101AZ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CT SCAN - MILSTEIN 3	177 Fort Washington Avenue	New York	NY	Active
DSH330101BA	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MRI - NEUROLOGY ICU	177 Fort Washington Avenue	New York	NY	Active
DSH330101BB	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	X-RAY VANDERBILT CLINIC EMERGENCY	622 West 168th Street	New York	NY	Terminated
DSH330101BC	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	X-RAY BABIES HOSPITAL	3959 Broadway	New York	NY	Active
DSH330101BD	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	VASCULAR INTERVENTIONAL	177 Fort Washington Avenue	New York	NY	Terminated
DSH330101BE	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NUCLEAR MEDICINE - MILSTEIN 3	177 Fort Washington Avenue	New York	NY	Active
DSH330101BF	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NUCLEAR CARDIOLOGY	177 Fort Washington Ave	New York	NY	Active
DSH330101BH	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	AIM PRACTICE EAST	1150 St. Nicholas Avenue	New York	NY	Active
DSH330101BJ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	SUPPORT SERVICE LAB	622 West 168th Street	New York	NY	Terminated
DSH330101BK	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS INTERVENTIONAL RADIOLOGY	3959 Broadway	New York	NY	Active
DSH330101BL	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS DIAGNOSTIC IMAGING	3959 Broadway	New York	NY	Active
DSH330101BM	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS ONCOLOGY CENTER	161 Fort Washington Avenue	New York	NY	Active
DSH330101BN	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS CARDIAC DIAGNOSTIC CENTER	3959 Broadway	New York	NY	Active
DSH330101BP	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS PULMONARY FUNCTION AND CARDIAC STRESS LAB	3959 Broadway	New York	NY	Active
DSH330101BQ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MAMMOGRAPHY	161 Fort Washington Avenue	New York	NY	Active
DSH330101BR	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS INFUSION CENTER	3959 Broadway	New York	NY	Active
DSH330101BT	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS RADIOLOGY	3959 Broadway	New York	NY	Active
DSH330101BU	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS EMERGENCY ROOM	3959 Broadway	New York	NY	Active
DSH330101BV	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS PACU	3959 Broadway	New York	NY	Active
DSH330101BW	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS OPERATING ROOM	3959 Broadway	New York	NY	Active
DSH330101BX	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Comprehensive Health Program	180 Ft. Washington Avenue	New York	NY	Active
DSH330101BY	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	X-RAY ALLEN HOSPITAL	5141 Broadway	New York	NY	Active
DSH330101BZ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	GAMMA KNIFE	3959 Broadway	New York	NY	Active
DSH330101CA	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	OPERATING ROOM ALLEN HOSPITAL	5141 Broadway	New York	NY	Active
DSH330101CB	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CARDIAC DIAGNOSTIC CENTER ALLEN HOSPITAL	5141 Broadway	New York	NY	Terminated
DSH330101CC	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	ENDOSCOPY ALLEN HOSPITAL	5141 Broadway	New York	NY	Active
DSH330101CD	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS URODYNAMICS	3959 Broadway	New York	NY	Terminated
DSH330101CE	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	COMPREHENSIVE TRANSPLANT	622 West 168th Street	New York	NY	Active
DSH330101CF	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	COLUMBIA PULMONARY FUNCTION LAB	622 West 168th Street	New York	NY	Active
DSH330101CG	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	AIM Practice West	622 West 168th Street	New York	NY	Active
DSH330101CH	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	ECHOCARDIOLOGY	177 Fort Washington Avenue	New York	NY	Terminated
DSH330101CJ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	ENDOSCOPY PRESBYTERIAN HOSPITAL	161 Fort Washington Avenue	New York	NY	Active
DSH330101CK	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	PHYSICAL MEDICINE CLINIC	622 West 168th Street	New York	NY	Terminated
DSH330101CM	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Dermatology	161 Fort Washington Ave.	New York	NY	Active
DSH330101CN	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	COLUMBIA EYE CLINIC	622 West 168th Street	New York	NY	Active
DSH330101CP	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	COLUMBIA CLINIC ORTHOPEDIC	710 West 168th Street	New York	NY	Active
DSH330101CQ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	COLUMBIA CLINIC SPECIALITIES	622 West 168th Street	New York	NY	Active
DSH330101CR	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Continuing Day Treatment Program	21 Bloomingdale Road	White Plains	NY	Terminated
DSH330101CS	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Continuum of Care Clinic	21 Bloomingdale Road	White Plains	NY	Terminated
DSH330101CT	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	WIC 168TH STREET	622 West 168th Street	New York	NY	Terminated
DSH330101CU	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	WIC NAGLE AVENUE	68 Nagle Avenue	New York	NY	Terminated
DSH330101CV	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	WIC 180TH STREET	549 West 180th Street	New York	NY	Terminated
DSH330101CW	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Women's Health/Special Needs	622 West 168th Street	New York	NY	Terminated
DSH330101CX	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CARDIAC HEALTH CENTER	1153 York Avenue	New York	NY	Terminated
DSH330101CZ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	ADULT METHADONE	505 East 70th Street	New York	NY	Active
DSH330101DA	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	WOMENS HEALTH PRACTICE	505 East 70th Street	New York	NY	Active
DSH330101DB	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	PEDIATRICS HEALTH PRACTICE	505 East 70th Street	New York	NY	Active
DSH330101DC	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CHILDRENS ENDOSCOPY AND BRONCHOSCOPY	3959 Broadway	New York	NY	Active
DSH330101DD	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Radiology	170 William Street	New York	NY	Active
DSH330101DE	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Interventional Radiology	170 William Street	New York	NY	Active
DSH330101DF	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Endoscopy	170 William Street	New York	NY	Active
DSH330101DG	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Ambulatory Surgery	170 William Street	New York	NY	Terminated
DSH330101DH	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Wellness Center	170 William Street	New York	NY	Terminated
DSH330101DJ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Operating Room	170 William Street	New York	NY	Active
DSH330101DK	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital PACU	170 William Street	New York	NY	Terminated
DSH330101DL	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Infusion Center	170 William Street	New York	NY	Active
DSH330101DM	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital Emergency	170 William Street	New York	NY	Active
DSH330101DN	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Harkness Pavilion / Hemotherapy/Apheresis	180 Fort Washington Avenue	New York	NY	Active
DSH330101DP	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Presbyterian Hospital / Renal Dialysis	622 West 168th Street	New York	NY	Active
DSH330101DQ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Project Stay - Youth Access	622 West 168th Street	NEW YORK	NY	Active
DSH330101DR	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Allen Hospital / Emergency Department	5141 Broadway	New York	NY	Active
DSH330101DS	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Allen Hospital / L&D	5141 Broadway	New York	NY	Terminated
DSH330101DT	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Allen Hospital / Radiology	5141 Broadway	New York	NY	Active
DSH330101DU	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Allen Hospital / PACU	5141 Broadway	New York	NY	Terminated
DSH330101DV	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	MSCH / L&D	3959 Broadway	New York	NY	Active
DSH330101DW	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	PH / Psych CPEP	622 West 168th Street	New York	NY	Terminated
DSH330101DX	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	PH /Radiation Oncology	622 West 168th Street	New York	NY	Active
DSH330101DY	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Dental Clinic NYP/CU	99 Fort Washington Ave	New York	NY	Active
DSH330101DZ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Pediatric Dental Clinic	505 East 70th Street	New York	NY	Active
DSH330101E	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Columbia Hospital- Blood Bank	180 Fort Washington Avenue	New York	NY	Terminated
DSH330101EA	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Adult Psychiatry Clinic - Psychiatry	622 West 168th Street	New York	NY	Active
DSH330101EB	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Pediatric Psychiatry Clinic - Psychiatry	3959 Broadway	New York	NY	Active
DSH330101EC	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	DHK Radiation Oncology	1283 York Avenue	New York	NY	Active
DSH330101ED	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	DHK Ambulatory Surgery	1283 York Avenue	New York	NY	Active
DSH330101EE	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	DHK Endoscopy - Surgery	1283 York Avenue	New York	NY	Active
DSH330101EF	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	DHK Interventional Radiology	1283 York Avenue	New York	NY	Active
DSH330101EG	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	DHK Infusion - Oncology	1283 York Avenue	New York	NY	Active
DSH330101EH	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Radiology Diagnostic	55 Palmer Avenue	Bronxville	NY	Active
DSH330101EJ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Interventional Radiology	55 Palmer Avenue	Bronxville	NY	Active
DSH330101EK	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Radiology Therapy	55 Palmer Avenue	Bronxville	NY	Active
DSH330101EL	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Operating Room	55 Palmer Avenue	Bronxville	NY	Active
DSH330101EM	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Cardiac Cath Lab	55 Palmer Avenue	Bronxville	NY	Active
DSH330101EN	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Ambulatory Surgery - Operating Room	55 Palmer Avenue	Bronxville	NY	Terminated
DSH330101EP	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Cancer Center Medical Oncology	55 Palmer Avenue	Bronxville	NY	Active
DSH330101EQ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Lab Patient Service Center	55 Palmer Avenue	Bronxville	NY	Active
DSH330101ER	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Emergency Room	55 Palmer Avenue	Bronxville	NY	Active
DSH330101ES	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW Respiratory Therapy	55 Palmer Avenue	Bronxville	NY	Terminated
DSH330101ET	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Allen Hospital / Geriatrics	5141 Broadway	New York	NY	Active
DSH330101EU	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Vascular Lab	506 6th Street	Brooklyn	NY	Active
DSH330101EV	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Rehabilitation Medicine	506 6th Street	Brooklyn	NY	Active
DSH330101EW	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Radiology	506 6th Street	Brooklyn	NY	Active
DSH330101EX	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Bay Ridge Nuclear Cardiology	8721 5th Avenue	Brooklyn	NY	Active
DSH330101EY	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - CT	506 6th Street	Brooklyn	NY	Active
DSH330101EZ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - L&D OR	506 6th Street	Brooklyn	NY	Active
DSH330101F	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Audubon Primary Care Practice	21 Audubon Avenue	New York	NY	Active
DSH330101FA	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Dental Clinic	506 6th Street	Brooklyn	NY	Active
DSH330101FB	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - EP Lab	506 6th Street	Brooklyn	NY	Active
DSH330101FC	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Endoscopy	506 6th Street	Brooklyn	NY	Active
DSH330101FD	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Advanced Women's Imaging	506 6th Street	Brooklyn	NY	Active
DSH330101FE	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Nuclear Medicine	506 6th Street	Brooklyn	NY	Active
DSH330101FF	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Cardiothoracic OR	506 6th Street	Brooklyn	NY	Active
DSH330101FG	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Cardiac Cath Lab	506 6th Street	Brooklyn	NY	Active
DSH330101FH	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Emergency Department	506 6th Street	Brooklyn	NY	Active
DSH330101FJ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Breast Center	506 6th Sreet	Brooklyn	NY	Active
DSH330101FK	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	OB/GYN Women’s Health Clinic	263 7th Avenue	Brooklyn	NY	Active
DSH330101FL	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Outpatient Imaging Center	506 6th Street	Brooklyn	NY	Terminated
DSH330101FM	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Ambulatory Surgery	506 6th Street	Brooklyn	NY	Terminated
DSH330101FN	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Main Medicine Clinic	506 6th Street	Brooklyn	NY	Active
DSH330101FP	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Radiation Oncology	506 6th Street	Brooklyn	NY	Active
DSH330101FQ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Main Operating Rooms	506 6th Street	Brooklyn	NY	Active
DSH330101FR	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - PFT Lab	506 6th Street	Brooklyn	NY	Active
DSH330101FS	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - PACU	506 6th Street	Brooklyn	NY	Terminated
DSH330101FT	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Comprehensive Epilepsy Center	506 6th Street	Brooklyn	NY	Active
DSH330101FU	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Interventional Radiology - Interventional Radiology	506 6th Street	Brooklyn	NY	Active
DSH330101FV	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - Women's Diagnostic Center	506 6th Street	Brooklyn	NY	Active
DSH330101FW	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Brooklyn Methodist - MRI	506 6th Street	Brooklyn	NY	Active
DSH330101FX	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	BMH Pediatric Clinic	263 7th Avenue	Brooklyn	NY	Active
DSH330101FY	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Operating Rooms	515 6th Street	Brooklyn	NY	Active
DSH330101FZ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Ambulatory Services	515 6th Street	Brooklyn	NY	Active
DSH330101G	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Urgi Care Center	21 Audubon Avenue	New York	NY	Terminated
DSH330101GA	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Endoscopy and Special Procedures	515 6th Street	Brooklyn	NY	Active
DSH330101GB	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Pre-Anesthesia Evaluation Center	515 6th Street	Brooklyn	NY	Active
DSH330101GC	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Infusion Services	515 6th Street	Brooklyn	NY	Active
DSH330101GD	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Surgical Services	515 6th Street	Brooklyn	NY	Active
DSH330101GE	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Family PEACE Trauma Treatment Center - Peace Program	99 Fort Washington Ave	New York	NY	Active
DSH330101GF	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Medical Services	515 6th Street	Brooklyn	NY	Active
DSH330101GG	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Oncology Services	515 6th Street	Brooklyn	NY	Active
DSH330101GH	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW - Endoscopy	55 Palmer Ave	Bronxville	NY	Active
DSH330101GJ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	DHK - GI - Transplant	1283 York Avenue	New York	NY	Active
DSH330101GK	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	DHK - Main OR	1283 York Avenue	New York	NY	Active
DSH330101GL	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	HIP - Thyroid Clinic	161 Fort Washington Ave	New York	NY	Active
DSH330101GM	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	WBH - ECT	21 Bloomingdale Road	White Plains	NY	Active
DSH330101GN	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Allen - PFT Lab	5141 Broadway	New York	NY	Active
DSH330101GP	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	WBHC - Adult Psychiatric Clinic	21 Bloomingdale Road	White Plains	NY	Active
DSH330101GQ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	CCH - Diagnostic Imaging Center	515 6th Street	Brooklyn	NY	Active
DSH330101GR	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	NYPW - PFT Lab	55 Palmer Ave	Bronxville	NY	Active
DSH330101GS	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Milstein - X-Ray Imaging	177 Fort Washington Ave	New York	NY	Active
DSH330101GT	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Lower Manhattan Hospital - PFT Lab	170 William Street	New York	NY	Active
DSH330101GU	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Allen Hospital - Same Day Surgery	5141 Broadway	New York	NY	Terminated
DSH330101GV	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Avon - Breast Imaging Center	1130 St. Nicholas Ave	New York	NY	Active
DSH330101GW	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Heart Center - X-Ray Imaging	173 Fort Washington Ave	New York	NY	Active
DSH330101GX	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Westchester Behavioral Health Center - Adult Partial Hospital	21 Bloomingdale Road	White Plains	NY	Active
DSH330101GY	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Helmsley Medical Tower - Internal Medicine	505 East 70th St	New York	NY	Active
DSH330101GZ	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Presbyterian Hospital - Transfusion Medicine	622 West 168th Street	New York	NY	Approved
DSH330101H	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Broadway Practice	4781-83 Broadway	New York	NY	Active
DSH330101J	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Charles B. Rangel Community Center	534 West 135 Street	New York	NY	Active
DSH330101K	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Family Medicine at the Herman Denny Farrell, Jr. Community Health Center	610 West 158th Street	New York	NY	Active
DSH330101L	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Washington Heights Family Health Center	575 West 181 Street	New York	NY	Active
DSH330101M	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Center for Special Studies-Roger Unit	53 West 23rd Street	New York	NY	Active
DSH330101P	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Eye Institute- Operating Room	635 West 165th Street	New York	NY	Terminated
DSH330101Q	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	I. SHERWOOD WRIGHT CENTER FOR AGING	1484 1ST AVE	New York	NY	Terminated
DSH330101R	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	George Washington High School	549 Audubon Ave	New York	NY	Active
DSH330101S	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Intermediate School 143	515 West 182nd Street	New York	NY	Active
DSH330101T	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Intermediate School 164	401 West 164th Street	New York	NY	Active
DSH330101U	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Intermediate School 52	650 Academy Street	New York	NY	Active
DSH330101V	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Project Stay	622 West 168th Street	New York	NY	Terminated
DSH330101X	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Thurgood Marshall Academy	200-214 West 135th Street	New York	NY	Active
DSH330101Y	Child	DSH	NEW YORK-PRESBYTERIAN HOSPITAL	Intermediate School 136	6 Edgecombe Avenue	New York	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/30/2023 3:53:17 PM	8/23/2024 3:24:43 PM	8/23/2024 3:24 PM
Addresses	Main Address	Update	Change Request	180 Ft. Washington Avenue HP, 6th Floor and 3rd Floor New York, NY 10032	180 Ft. Washington Avenue HP, 6th Floor and 3rd Floor VC-3 New York, NY 10032	1/19/2024 9:28 AM
Details	Entity Subname	Update	Change Request	Comprehensive HIV Program	Comprehensive Health Program	1/19/2024 9:28 AM
Addresses	Main Address	Update	Recertification	180 Ft. Washington Avenue HP, 6th Floor New York, NY 10032	180 Ft. Washington Avenue HP, 6th Floor and 3rd Floor New York, NY 10032	8/30/2023 3:53 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 2:14:31 PM	8/30/2023 3:53:17 PM	8/30/2023 3:53 PM
Details	Last Recertification Date	Update	Recertification	8/31/2021 1:24:26 PM	9/12/2022 2:14:31 PM	9/12/2022 2:14 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 2:27:22 PM	8/31/2021 1:24:26 PM	8/31/2021 1:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 2:27 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4148509	9/9/2020 2:27 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/9/2020 2:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194832477	9/9/2020 2:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/9/2020 2:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NJ	9/9/2020 2:27 PM
Details	Last Recertification Date	Update	Recertification	9/6/2019 10:39:55 AM	9/9/2020 2:27:22 PM	9/9/2020 2:27 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 2:39:52 PM	9/6/2019 10:39:55 AM	9/6/2019 10:39 AM
Details	Last Recertification Date	Update	Recertification	11/21/2017 2:19:21 PM	8/21/2018 2:39:52 PM	8/21/2018 2:39 PM
Details	Last Recertification Date	Update	Recertification	10/25/2017 7:47:32 AM	11/21/2017 2:19:21 PM	11/21/2017 2:19 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	10/25/2017 7:47:32 AM	10/25/2017 7:47 AM
Contacts	Authorizing Official	Update		Farrell, William SVP, Finance 2122974358	Farrell, William SVP, Finance New York Presbyterian 2122974358	9/27/2017 2:58 PM
Contacts	Primary Contact	Update		Gharia, Gajendra Director of Finance, Dept of 340B Programs 2122974353	Gharia, Gajendra Director of Finance, Dept of 340B Programs NewYork-Presbyterian Hospital 2122974353	9/27/2017 2:01 PM
Contacts	Authorizing Official	Insert			Farrell, William SVP, Finance 2122974358	8/9/2017 2:20 PM
Contacts	Signed By	Insert			WOLLENBURG, KAROL VP, PHARMACY SERVICES 2123056592	5/25/2017 9:22 AM
Contacts	Primary Contact	Insert			Gharia, Gajendra Director of Finance, Dept of 340B Programs 2122974353	3/23/2017 7:52 AM
Addresses	Main Address	Insert			180 Ft. Washington Avenue HP, 6th Floor New York, NY 10032	3/3/2017 5:02 PM
Addresses	Billing Address	Insert			NewYork-Presbyterian Hospital 525 East 68th Street New York, NY 10065	3/3/2017 5:02 PM
Addresses	Shipping Address	Insert			NewYork-Presbyterian Hospital 622 West 168th Street VCB Main Pharmacy New York, NY 10032	3/3/2017 5:02 PM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 2:53 PM
Details	Last Recertification Date	Update		8/18/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/25/2015 10:02 AM
Details	Last Recertification Date	Update		9/6/2013 1:31:26 PM	8/18/2014 12:00:00 AM	8/18/2014 2:24 PM
Details	Last Recertification Date	Update			9/6/2013 1:31:26 PM	9/6/2013 1:31 PM
Details	Entity Subname	Update		AIDS MEDICAL PROGRAM	Comprehensive HIV Program	4/30/2013 12:26 PM
Details	340B ID	Update		IS-JH-DSH330101BX	DSH330101BX	6/28/2012 2:22 PM
Dates	Participating Approval Date	Update			6/28/2012 12:00:00 AM	6/28/2012 2:22 PM
Details	State	Update		Pending	Active	6/28/2012 2:22 PM
Dates	Start Date	Update			7/1/2012 12:00:00 AM	6/28/2012 2:22 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-JH-DSH330101BX	6/18/2012 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/30/2012 11:38 AM
Medicaid Billing	Medicaid: Number	Insert			00243178	5/30/2012 11:38 AM
Medicaid Billing	Medicaid: State	Insert			NY	5/30/2012 11:38 AM
Medicaid Billing	NPI: Number	Insert			1194832477	5/30/2012 11:38 AM
Details	Last Recertification Date	Insert				5/30/2012 11:38 AM
Details	Grant Number	Insert				5/30/2012 11:38 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	5/30/2012 11:38 AM
Details	Is Authorizing Official EHB Data	Insert				5/30/2012 11:38 AM
Dates	Last Date That 340B Drugs Purchased	Insert				5/30/2012 11:38 AM
Details	Medicare Provider Number	Insert			330101	5/30/2012 11:38 AM
Details	Entity Name	Insert			NEW YORK-PRESBYTERIAN HOSPITAL	5/30/2012 11:38 AM
Details	Program Code	Insert			DSH	5/30/2012 11:38 AM
Details	Entity Subname	Insert			AIDS MEDICAL PROGRAM	5/30/2012 11:38 AM
Dates	Participating Approval Date	Insert				5/30/2012 11:38 AM
Details	State	Insert			Pending	5/30/2012 11:38 AM
Dates	Registration Date	Insert			5/30/2012 12:00:00 AM	5/30/2012 11:38 AM
Dates	Signed By Date	Insert			5/30/2012 12:00:00 AM	5/30/2012 11:38 AM
Dates	Start Date	Insert				5/30/2012 11:38 AM
Terminations	Termination Comments	Insert				5/30/2012 11:38 AM
Terminations	Termination Date	Insert				5/30/2012 11:38 AM
Terminations	Termination Effective Date	Insert				5/30/2012 11:38 AM
Terminations	Termination Reason	Insert				5/30/2012 11:38 AM