Covered Entity Details

CAH331311-01 Little Falls Hospital (Active) - information as of 4/23/2025 10:51:18 PM

Main Details

Name

Little Falls Hospital

Subdivision Name

Dolgeville Primary Care Center

Type

Critical Access Hospital

Rural

340B ID

CAH331311-01

Medicare Provider Number

331311

Outpatient Facility Provider Number

333984

Additional Details

Current Program Status

Active

Registration Date

1/14/2013

Participating Start Date

2/13/2013

Participating Approval Date

2/13/2013

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Bassett Healthcare Network
James Vielkind, Vice President Finance
(315) 823-5281

Primary Contact

Bassett Healthcare - Cooperstown, NY
Kim Metcalf, Chief Pharmacy Officer
(860) 975-5636

Addresses

Street Address

36 Slawson Street
Dolgeville, NY 13329

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
NY		1174009112,1467593202,1558321919

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
CAH331311-01	Child	CAH	Little Falls Hospital	Dolgeville Primary Care Center	36 Slawson Street	Dolgeville	NY	Active
CAH331311-02	Child	CAH	Little Falls Hospital	Newport Primary Care Center	3085 Bridge Street	Newport	NY	Terminated
CAH331311-03	Child	CAH	Little Falls Hospital	Richfield Springs Health Center - Rural Health Clinic	8550 State Highway 28	Richfield Springs	NY	Active
CAH331311-04	Child	CAH	Little Falls Hospital	West Winfield Health Center - Rural Health Clinic	544 E Main Street	West Winfield	NY	Active
CAH331311-05	Child	CAH	Little Falls Hospital	Little Falls Health Center - Rural Health Clinic	170 Burwell Street	Little Falls	NY	Active
CAH331311-06	Child	CAH	Little Falls Hospital	St. Johnsville Health Center - Rural Health Clinic	8 Park Place	St. Johnsville	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Change Request		1174009112	3/12/2025 4:32 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	3/12/2025 4:32 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467593202	3/12/2025 4:32 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	3/12/2025 4:32 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1558321919	3/12/2025 4:32 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	3/12/2025 4:32 AM
Details	Last Recertification Date	Update	Recertification	8/24/2023 5:20:39 PM	8/29/2024 9:28:02 AM	8/29/2024 9:28 AM
Contacts	Authorizing Official	Update	Change Request	DiStefano, Guy VP of Financial Operations Bassett Healthcare Network 6075473692	Vielkind, James Vice President Finance Bassett Healthcare Network 3158235281	3/22/2024 7:54 AM
Contacts	Primary Contact	Update	PC Change Request	McCall, Russell 340B Coordinator Bassett Healthcare Network 6075473347	Metcalf, Kim Chief Pharmacy Officer Bassett Healthcare - Cooperstown, NY 8609755636	3/20/2024 12:46 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 3:20:37 PM	8/24/2023 5:20:39 PM	8/24/2023 5:20 PM
Contacts	Authorizing Official	Update	Change Request	Swinko, Paul CFO Bassett Healthcare Network 6075473096	DiStefano, Guy VP of Financial Operations Bassett Healthcare Network 6075473692	1/9/2023 11:02 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 12:54:55 PM	8/26/2022 3:20:37 PM	8/26/2022 3:20 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 6:38:31 PM	8/16/2021 12:54:55 PM	8/16/2021 12:54 PM
Contacts	Primary Contact	Update	Change Request	Camardello, Jamie Pharmacist Little Falls Hospital 3158235242	McCall, Russell 340B Coordinator Bassett Healthcare Network 6075473347	6/5/2021 10:21 AM
Contacts	Authorizing Official	Update	Change Request	Vielkind, James CFO little falls hospital 3158235281	Swinko, Paul CFO Bassett Healthcare Network 6075473096	6/4/2021 8:07 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 7:17:02 AM	9/10/2020 6:38:31 PM	9/10/2020 6:38 PM
Addresses	Main Address	Update	Change Request	9 Gibson Street Dolgeville, NY 13329	36 Slawson Street Dolgeville, NY 13329	7/20/2020 11:34 AM
Details	Last Recertification Date	Update	Recertification	8/30/2018 10:54:56 AM	8/28/2019 7:17:02 AM	8/28/2019 7:17 AM
Details	Last Recertification Date	Update	Recertification	11/27/2017 4:20:24 PM	8/30/2018 10:54:56 AM	8/30/2018 10:54 AM
Contacts	Primary Contact	Insert	Recertification		Camardello, Jamie Pharmacist Little Falls Hospital 3158235242	11/27/2017 4:20 PM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/27/2017 4:20:24 PM	11/27/2017 4:20 PM
Contacts	Authorizing Official	Update		Vielkind, James CFO 3158235281	Vielkind, James CFO little falls hospital 3158235281	10/10/2017 11:16 AM
Contacts	Signed By	Update		Vielkind, James CFO 3158235281	Vielkind, James CFO little falls hospital 3158235281	10/10/2017 11:16 AM
Contacts	Authorizing Official	Insert			Vielkind, James CFO 3158235281	9/28/2016 2:20 PM
Contacts	Signed By	Insert			Vielkind, James CFO 3158235281	9/28/2016 2:20 PM
Addresses	Main Address	Insert			9 Gibson Street Dolgeville, NY 13329	9/1/2016 10:36 AM
Details	Last Recertification Date	Update		9/3/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 10:36 AM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	9/3/2015 12:00:00 AM	9/3/2015 3:40 PM
Details	Last Recertification Date	Update		8/21/2013 12:00:00 AM	9/5/2014 12:00:00 AM	9/5/2014 12:06 PM
Details	Last Recertification Date	Update			8/21/2013 12:00:00 AM	8/21/2013 8:04 AM
Dates	Start Date	Update		4/1/2013 12:00:00 AM	2/13/2013 12:00:00 AM	2/13/2013 3:23 PM
Details	340B ID	Update		ISJMCAH331311A	CAH331311-01	2/13/2013 10:16 AM
Dates	Participating Approval Date	Update			2/13/2013 12:00:00 AM	2/13/2013 10:16 AM
Details	State	Update		Pending	Active	2/13/2013 10:16 AM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/13/2013 10:16 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISJMCAH331311A	2/11/2013 2:20 PM
Details	Last Recertification Date	Insert				1/14/2013 3:22 PM
Details	Grant Number	Insert				1/14/2013 3:22 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/14/2013 3:22 PM
Details	Is Authorizing Official EHB Data	Insert				1/14/2013 3:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2013 3:22 PM
Details	Medicare Provider Number	Insert			331311	1/14/2013 3:22 PM
Details	Entity Name	Insert			Little Falls Hospital	1/14/2013 3:22 PM
Details	Program Code	Insert			CAH	1/14/2013 3:22 PM
Details	Entity Subname	Insert			Dolgeville Primary Care Center	1/14/2013 3:22 PM
Dates	Participating Approval Date	Insert				1/14/2013 3:22 PM
Details	State	Insert			Pending	1/14/2013 3:22 PM
Dates	Registration Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 3:22 PM
Dates	Signed By Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 3:22 PM
Dates	Start Date	Insert				1/14/2013 3:22 PM
Terminations	Termination Comments	Insert				1/14/2013 3:22 PM
Terminations	Termination Date	Insert				1/14/2013 3:22 PM
Terminations	Termination Effective Date	Insert				1/14/2013 3:22 PM
Terminations	Termination Reason	Insert				1/14/2013 3:22 PM