Covered Entity Details

DSH330208AM St. John's Riverside Hospital (Terminated) - information as of 5/2/2025 10:39:34 PM

Main Details

Name

St. John's Riverside Hospital

Subdivision Name

Recovery Andrus

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330208AM

Medicare Provider Number

330208

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/15/2012

Participating Start Date

10/27/2012

Participating Approval Date

10/26/2012

Last Recertification Date

8/27/2014

Termination Date
Termination Reason

10/1/2015
Site closure

Contacts

Authorizing Official

St John's Riverside Hospital
Tara Curtin-Paloka, Vice President and Chief Nursing Officer
(914) 964-4789

Primary Contact

John Masi, Director of Pharmacy
(914) 964-4847

Addresses

Street Address

967 North Broadway
Yonkers, NY 10701

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
11/2/2012 – Participation start date changed from 1/1/2013 to 10/27/2012 to reflect post-Sandy public health emergency determination for the State of New York [T.Lew]	11/05/2012

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	245501

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
DSH330208A	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL		2 PARK AVENUE	YONKERS	NY	Terminated
DSH330208AA	Child	DSH	St. John's Riverside Hospital	HYPERBARIC ROOM	967 North Broadway	Yonkers	NY	Terminated
DSH330208AB	Child	DSH	St. John's Riverside Hospital	METHADONE MAINTENANCE	2 PARK AVENUE	Yonkers	NY	Terminated
DSH330208AC	Child	DSH	St. John's Riverside Hospital	MRI ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208AD	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	MRI Dobbs Ferry	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208AE	Child	DSH	St. John's Riverside Hospital	Nuclear Medicine Andrus	967 North Broadway	Yonkers	NY	Terminated
DSH330208AF	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	Nuclear Medicine Dobbs Ferry	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208AG	Child	DSH	St. John's Riverside Hospital	O/R Andrus	967 North Broadway	Yonkers	NY	Terminated
DSH330208AH	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	O/R Dobbs Ferry	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208AJ	Child	DSH	St. John's Riverside Hospital	PHYSICAL THERAPY ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208AK	Child	DSH	St. John's Riverside Hospital	Radiology Andrus	967 North Broadway	Yonkers	NY	Terminated
DSH330208AL	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	Radiology Dobbs Ferry	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208AM	Child	DSH	St. John's Riverside Hospital	Recovery Andrus	967 North Broadway	Yonkers	NY	Terminated
DSH330208AN	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	Recovery Dobbs Ferry	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208AP	Child	DSH	St. John's Riverside Hospital	RESPIRATORY ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208AQ	Child	DSH	St. John's Riverside Hospital	SAMSHA	2 PARK AVENUE	Yonkers	NY	Terminated
DSH330208AR	Child	DSH	St. John's Riverside Hospital	SLEEP CENTER	128 Ashford Avenue	Dobbs Ferry	NY	Terminated
DSH330208AS	Child	DSH	St. John's Riverside Hospital	ULTRASOUND ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208AT	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	ULTRASOUND DOBBS FERRY	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208AU	Child	DSH	St. John's Riverside Hospital	WOUND CARE	967 North Broadway	Yonkers	NY	Terminated
DSH330208AV	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	HOPE CENTER - HOPE CENTER	2 PARK AVENUE	YONKERS	NY	Active
DSH330208B	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	ARCHWAY	20 EAST 1ST STREET	MT VERNON	NY	Active
DSH330208C	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	SOLUTIONS	10 WOODS ROAD	VALHALLA	NY	Terminated
DSH330208D	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	HAWTHORNE CEDAR KNOLLS	226 LINDA AVENUE	HAWTHORNE	NY	Terminated
DSH330208E	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	WESTHELP GREENBURGH	1 WESTHELP DRIVE	WHITE PLAINS	NY	Terminated
DSH330208F	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	NEW FOCUS CENTER	70 ASHBURTON AVENUE	YONKERS	NY	Terminated
DSH330208G	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	MMTP	2 Park Avenue	YONKERS	NY	Terminated
DSH330208H	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	GREENBURGH ATS & HOMELESS SHELTER	30 MANHATTAN AVENUE	WHITE PLAINS	NY	Active
DSH330208J	Child	DSH	St. John's Riverside Hospital	ASU ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208K	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	ASU DOBBS FERRY	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208L	Child	DSH	St. John's Riverside Hospital	CAT SCAN ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208M	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	CAT SCAN DOBBS FERRY	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208N	Child	DSH	St. John's Riverside Hospital	E/R ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208P	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	E/R DOBBS FERRY	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208Q	Child	DSH	St. John's Riverside Hospital	EKG ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208R	Child	DSH	St. John's Riverside Hospital	ENDOSCOPY ANDRUS	967 North Broadway	Yonkers	NY	Terminated
DSH330208S	Child	DSH	ST JOHNS RIVERSIDE HOSPITAL	ENDOSCOPY DOBBS FERRY	128 Ashford Avenue	Dobbs Ferry	NY	Active
DSH330208T	Child	DSH	St. John's Riverside Hospital	HC COBRA	2 PARK AVENUE	Yonkers	NY	Terminated
DSH330208U	Child	DSH	St. John's Riverside Hospital	HC GREYSTONE HIV	2 PARK AVENUE	Dobbs Ferry	NY	Terminated
DSH330208V	Child	DSH	St. John's Riverside Hospital	HOPE CENTER 11	2 PARK AVENUE	Yonkers	NY	Terminated
DSH330208W	Child	DSH	St. John's Riverside Hospital	HOPE CENTER 111	2 PARK AVENUE	Yonkers	NY	Terminated
DSH330208X	Child	DSH	St. John's Riverside Hospital	HOPE CENTER ACCESS	2 PARK AVENUE	Yonkers	NY	Terminated
DSH330208Y	Child	DSH	St. John's Riverside Hospital	HOPE CENTER HIV	2 PARK AVENUE	Yonkers	NY	Terminated
DSH330208Z	Child	DSH	St. John's Riverside Hospital	HOPE CENTER MAINTENANCE	2 PARK AVENUE	Yonkers	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	MCGREGOR, DONNA COO St. John's Riverside Hospital 9149648831	Curtin-Paloka, Tara Vice President and Chief Nursing Officer St John's Riverside Hospital 9149644789	7/17/2019 7:35 AM
Contacts	Authorizing Official	Update		MCGREGOR, DONNA COO 9149648831	MCGREGOR, DONNA COO St. John's Riverside Hospital 9149648831	11/27/2017 10:16 AM
Contacts	Authorizing Official	Update		Nelson, Lynn EVP/COO 9149644521	MCGREGOR, DONNA COO 9149648831	9/11/2017 3:29 PM
Contacts	Primary Contact	Insert			Masi, John Director of Pharmacy 9149644847	8/10/2016 11:12 AM
Contacts	Signed By	Insert			Masi, John Director of Pharmacy 9149644847	8/10/2016 11:12 AM
Contacts	Authorizing Official	Insert			Nelson, Lynn EVP/COO 9149644521	1/5/2016 11:28 AM
Addresses	Main Address	Insert			967 North Broadway Yonkers, NY 10701	7/30/2015 10:15 AM
Dates	Last Date That 340B Drugs Purchased	Update			7/15/2015 12:00:00 AM	7/30/2015 10:15 AM
Details	State	Update		Active	Terminated	7/30/2015 10:15 AM
Terminations	Termination Comments	Update			Site is within the 4 walls of the parent site and therefore it is not necessary to register.	7/30/2015 10:15 AM
Terminations	Termination Date	Update			10/1/2015 12:00:00 AM	7/30/2015 10:15 AM
Terminations	Termination Effective Date	Update			7/15/2015 12:00:00 AM	7/30/2015 10:15 AM
Terminations	Termination Reason	Update			Site closure	7/30/2015 10:15 AM
Details	Last Recertification Date	Update		8/26/2013 7:21:53 AM	8/27/2014 12:00:00 AM	8/27/2014 1:56 PM
Details	Last Recertification Date	Update			8/26/2013 7:21:53 AM	8/26/2013 7:21 AM
Details	Comments Public	Insert			11/2/2012 – Participation start date changed from 1/1/2013 to 10/27/2012 to reflect post-Sandy public health emergency determination for the State of New York [T.Lew]	11/5/2012 10:54 AM
Dates	Start Date	Update		1/1/2013 12:00:00 AM	10/27/2012 12:00:00 AM	11/2/2012 4:59 PM
Details	340B ID	Update		IS-AP-DSH330208AM	DSH330208AM	10/26/2012 10:59 AM
Details	Entity Name	Update		St.John's Riverside Hospital	St. John's Riverside Hospital	10/26/2012 10:59 AM
Dates	Participating Approval Date	Update			10/26/2012 12:00:00 AM	10/26/2012 10:59 AM
Details	State	Update		Pending	Active	10/26/2012 10:59 AM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	10/26/2012 10:59 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-AP-DSH330208AM	10/16/2012 2:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/15/2012 3:10 PM
Medicaid Billing	Medicaid: Number	Insert			245501	10/15/2012 3:10 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/15/2012 3:10 PM
Details	Last Recertification Date	Insert				10/15/2012 3:10 PM
Details	Grant Number	Insert				10/15/2012 3:10 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/15/2012 3:10 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2012 3:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2012 3:10 PM
Details	Medicare Provider Number	Insert			330208	10/15/2012 3:10 PM
Details	Entity Name	Insert			St.John's Riverside Hospital	10/15/2012 3:10 PM
Details	Program Code	Insert			DSH	10/15/2012 3:10 PM
Details	Entity Subname	Insert			Recovery Andrus	10/15/2012 3:10 PM
Dates	Participating Approval Date	Insert				10/15/2012 3:10 PM
Details	State	Insert			Pending	10/15/2012 3:10 PM
Dates	Registration Date	Insert			10/15/2012 12:00:00 AM	10/15/2012 3:10 PM
Dates	Signed By Date	Insert			10/15/2012 12:00:00 AM	10/15/2012 3:10 PM
Dates	Start Date	Insert				10/15/2012 3:10 PM
Terminations	Termination Comments	Insert				10/15/2012 3:10 PM
Terminations	Termination Date	Insert				10/15/2012 3:10 PM
Terminations	Termination Effective Date	Insert				10/15/2012 3:10 PM
Terminations	Termination Reason	Insert				10/15/2012 3:10 PM