Covered Entity Details

DSH310064W ATLANTICARE REGIONAL MEDICAL CENTER (Active) - information as of 5/4/2025 10:26:44 PM

Main Details

Name

ATLANTICARE REGIONAL MEDICAL CENTER

Subdivision Name

MAINLAND Non-Invasive Department

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310064W

Medicare Provider Number

310064

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

6/11/2012

Participating Start Date

7/1/2012

Participating Approval Date

6/29/2012

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

AtlantiCare
Hak Kim, Chief Financial Officer
(609) 569-7031

Primary Contact

AtlantiCare Regional Medical Center
Timothy Joseph Ryan, Reimbursement Manager
(609) 383-2805

Addresses

Street Address

65 W. Jimmie Leeds Road
Pomona, NJ 08240-9102

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
NJ	4139402	1013919315

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
DSH310064AA	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Radiology	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064AB	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Respiratory Therapy	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064AC	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Special Radiology Procedures	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064AD	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Outpatient Services PreNatal	2500 English Creek Ave.	Egg Harbor Township	NJ	Terminated
DSH310064AE	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Radiation Therapy	2500 English Creek Ave	Egg Harbor Township	NJ	Active
DSH310064AF	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ARMC Cancer Care Institute/ EHT Medical Oncology	2500 English Creek Ave	Egg Harbor Township	NJ	Active
DSH310064AG	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Satellite ED	219 N. White Horse Pike	Hammonton	NJ	Active
DSH310064AH	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	SCC - Galloway	54 W. Jimmie Leeds Road	Galloway	NJ	Terminated
DSH310064AJ	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Specialty Care Clinic (SCC)	1401 Atlantic Ave.	Atlantic City	NJ	Terminated
DSH310064AK	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ARMC Adult Partial Care Services	400 Chris Gaupp Drive	Galloway	NJ	Active
DSH310064AL	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ARMC MICU	6685 Washington Ave	Egg Harbor Township	NJ	Active
DSH310064AM	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ARMC Wound Healing Center	2500 English Creek Road	Egg Harbor Township	NJ	Active
DSH310064AN	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	HEALTHPLEX Clinic Service - Ambulatory Care	1401 Atlantic Avenue	Atlantic City	NJ	Active
DSH310064AP	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Hammonton Cardiac Diagnostics	219 N. White Horse Pike	Hammonton	NJ	Terminated
DSH310064AQ	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Hammonton Wound Care Center	219 N. White Horse Pike	Hammonton	NJ	Active
DSH310064AR	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	healthplex trauma/surgery outpatient clinic	1401 Atlantic Avenue	Atlantic City	NJ	Terminated
DSH310064AS	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Infectious Disease Clinic	1401 Atlantic Avenue	Atlantic City	NJ	Active
DSH310064AT	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Recovery Room	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064AU	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	HBO	2500 English Creek Road	Egg Harbor Township	NJ	Active
DSH310064AV	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ARMC Cancer Care Institute/Cape May Medical Oncology	106 Court House, South Dennis Road	Cape May Court House	NJ	Active
DSH310064AW	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ARMC Cancer Care Institute/ Cape May Radiation Therapy	106 Court House, South Dennis Road	Cape May Court House	NJ	Active
DSH310064AX	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Child Partial Hospitalization Program	6010 Black Horse Pike	Egg Harbor Township	NJ	Active
DSH310064AY	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Special Care Center / Comprehensive Wellness Center	1401 ATLANTIC AVENUE	ATLANTIC CITY	NJ	Active
DSH310064AZ	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Enhanced Care Center	1401 ATLANTIC AVE	ATLANTIC CITY	NJ	Active
DSH310064BA	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Palliative Care Clinic	1401 ATLANTIC AVE	ATLANTIC CITY	NJ	Active
DSH310064BB	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ATLANTICARE REGIONAL MEDICAL CENTER / cardiac pacemaker clinic	65 W. JIMMIE LEEDS ROAD	POMONA	NJ	Active
DSH310064BC	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND Vascular Program	65 W JIMMIE LEEDS ROAD	POMONA	NJ	Terminated
DSH310064BD	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND EEG Department	65 W. JIMMIE LEEDS ROAD	POMONA	NJ	Active
DSH310064BE	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	HEALTHPLEX Anticoagulation Clinic	1401 ATLANTIC AVE	ATLANTIC CITY	NJ	Terminated
DSH310064BF	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	HEALTHPLEX Maternal Fetal Medicine	7 S. Ohio Ave	ATLANTIC CITY	NJ	Active
DSH310064BG	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND Anticoagulation Clinic	65 W. JIMMIE LEEDS ROAD	Pomona	NJ	Active
DSH310064BH	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ATLANTICARE REGIONAL MEDICAL CENTER - Same Day Surgery - Mainland - 67740	65 W JIMMIE LEEDS RD	POMONA	NJ	Active
DSH310064BJ	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ATLANTICARE REGIONAL MEDICAL CENTER - EHT Med Onc Phys Prac - 68403	2500 ENGLISH CREEK AVENUE	EGG HARBOR TOWNSHIP	NJ	Active
DSH310064BK	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ATLANTICARE REGIONAL MEDICAL CENTER - Family Planning - 8055	1401 ATLANTIC AVENUE	ATLANTIC CITY	NJ	Active
DSH310064BL	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	ATLANTICARE REGIONAL MEDICAL CENTER - CAPE MAY MEDICAL ONCOLOGY PP - 8404	106 COURT HOUSE SOUTH DENNIS RD 200	CAPE MAY COURT HOUSE	NJ	Active
DSH310064G	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	CARDIAC DIAGNOSTIC HEALTH PARK	2500 ENGLISH CREEK AVENUE	EGG HARBOR TOWNSHIP	NJ	Terminated
DSH310064M	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Anesthesia Department	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064N	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND Bloodless Medicine and Surgery Program	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064P	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Cath Lab	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064Q	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland CT Scan	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064R	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Delivery Room	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064S	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND Electrophysiology Lab	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064T	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Emergency Room	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064U	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND Endoscopy	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064V	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland MRI	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064W	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND Non-Invasive Department	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064X	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Nuclear Medicine	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064Y	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	Mainland Operating Room	65 W. Jimmie Leeds Road	Pomona	NJ	Active
DSH310064Z	Child	DSH	ATLANTICARE REGIONAL MEDICAL CENTER	MAINLAND Perinatology	65 W. Jimmie Leeds Road	Pomona	NJ	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 8:47:02 AM	8/19/2024 8:36:52 AM	8/19/2024 8:36 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 11:48:29 AM	8/15/2023 8:47:02 AM	8/15/2023 8:47 AM
Details	Last Recertification Date	Update	Recertification	9/2/2021 2:39:08 PM	9/1/2022 11:48:29 AM	9/1/2022 11:48 AM
Details	Last Recertification Date	Update	Recertification	8/19/2020 4:49:28 PM	9/2/2021 2:39:08 PM	9/2/2021 2:39 PM
Contacts	Primary Contact	Update	Change Request	Besler, Scott Richard Corp Director AtlantiCare 6093832117	Ryan, Timothy Joseph Reimbursement Manager AtlantiCare Regional Medical Center 6093832805	6/9/2021 6:39 AM
Medicaid Billing	NPI: State	Update	Recertification		NJ	8/19/2020 4:49 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 8:08:19 AM	8/19/2020 4:49:28 PM	8/19/2020 4:49 PM
Contacts	Primary Contact	Update	Change Request	Fenton, Christin Reimbursement Manager AtlantiCare Regional Medical Center 6096777171	Besler, Scott Richard Corp Director AtlantiCare 6093832117	5/15/2020 9:24 AM
Details	Last Recertification Date	Update	Recertification	8/28/2018 5:25:32 PM	8/29/2019 8:08:19 AM	8/29/2019 8:08 AM
Details	Entity Subname	Update	Recertification	Mainland Non-invasive department	MAINLAND Non-Invasive Department	8/29/2019 8:08 AM
Contacts	Primary Contact	Update	Recertification	nuzzo, rosemary Director, Finance armc 6093832114	Fenton, Christin Reimbursement Manager AtlantiCare Regional Medical Center 6096777171	8/28/2018 5:25 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 10:45:59 AM	8/28/2018 5:25:32 PM	8/28/2018 5:25 PM
Contacts	Authorizing Official	Update	Change Request	Greiner, Walter VP, Finance and CFO ARMC 6093832111	Kim, Hak Chief Financial Officer AtlantiCare 6095697031	1/24/2018 3:12 PM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	11/8/2017 10:45:59 AM	11/8/2017 10:45 AM
Contacts	Primary Contact	Update		nuzzo, rosemary Director, Finance 6093832114	nuzzo, rosemary Director, Finance armc 6093832114	10/18/2017 12:48 PM
Contacts	Authorizing Official	Update		Greiner, Walter VP, Finance and CFO 6093832111	Greiner, Walter VP, Finance and CFO ARMC 6093832111	10/18/2017 12:41 PM
Contacts	Signed By	Update		Greiner, Walter VP, Finance and CFO 6093832111	Greiner, Walter VP, Finance and CFO ARMC 6093832111	10/18/2017 12:41 PM
Contacts	Primary Contact	Insert			nuzzo, rosemary Director, Finance 6093832114	3/7/2017 8:49 AM
Contacts	Authorizing Official	Insert			Greiner, Walter VP, Finance and CFO 6093832111	3/7/2017 8:49 AM
Contacts	Signed By	Insert			Greiner, Walter VP, Finance and CFO 6093832111	3/7/2017 8:49 AM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	8/12/2016 12:00:00 AM	8/12/2016 2:19 PM
Addresses	Main Address	Insert			65 W. Jimmie Leeds Road Pomona, NJ 08240-9102	8/12/2016 2:19 PM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/24/2015 10:54 AM
Details	Last Recertification Date	Update		9/6/2013 3:36:04 PM	8/27/2014 12:00:00 AM	8/27/2014 3:29 PM
Details	Last Recertification Date	Update			9/6/2013 3:36:04 PM	9/6/2013 3:36 PM
Details	340B ID	Update		JH?-DSH310064W	DSH310064W	6/29/2012 12:54 PM
Dates	Participating Approval Date	Update			6/29/2012 12:00:00 AM	6/29/2012 12:54 PM
Details	State	Update		Pending	Active	6/29/2012 12:54 PM
Dates	Start Date	Update			7/1/2012 12:00:00 AM	6/29/2012 12:54 PM
Details	340B ID	Update		JH?-DSH310064R	JH?-DSH310064W	6/29/2012 12:50 PM
Details	340B ID	Update		IS-JH-DSH310064R	JH?-DSH310064R	6/21/2012 10:59 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-JH-DSH310064R	6/14/2012 3:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/11/2012 11:48 AM
Medicaid Billing	Medicaid: Number	Insert			4139402	6/11/2012 11:48 AM
Medicaid Billing	Medicaid: State	Insert			NJ	6/11/2012 11:48 AM
Medicaid Billing	NPI: Number	Insert			1013919315	6/11/2012 11:48 AM
Details	Last Recertification Date	Insert				6/11/2012 11:48 AM
Details	Grant Number	Insert				6/11/2012 11:48 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	6/11/2012 11:48 AM
Details	Is Authorizing Official EHB Data	Insert				6/11/2012 11:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert				6/11/2012 11:48 AM
Details	Medicare Provider Number	Insert			310064	6/11/2012 11:48 AM
Details	Entity Name	Insert			ATLANTICARE REGIONAL MEDICAL CENTER	6/11/2012 11:48 AM
Details	Program Code	Insert			DSH	6/11/2012 11:48 AM
Details	Entity Subname	Insert			Mainland Non-invasive department	6/11/2012 11:48 AM
Dates	Participating Approval Date	Insert				6/11/2012 11:48 AM
Details	State	Insert			Pending	6/11/2012 11:48 AM
Dates	Registration Date	Insert			6/11/2012 12:00:00 AM	6/11/2012 11:48 AM
Dates	Signed By Date	Insert			6/11/2012 12:00:00 AM	6/11/2012 11:48 AM
Dates	Start Date	Insert				6/11/2012 11:48 AM
Terminations	Termination Comments	Insert				6/11/2012 11:48 AM
Terminations	Termination Date	Insert				6/11/2012 11:48 AM
Terminations	Termination Effective Date	Insert				6/11/2012 11:48 AM
Terminations	Termination Reason	Insert				6/11/2012 11:48 AM