Covered Entity Details

DSH310119C UH - UNIVERSITY HOSPITAL (Active) - information as of 6/5/2025 2:38:44 PM

Main Details

Name

UH - UNIVERSITY HOSPITAL

Subdivision Name

Opthalmology Serv/DOC Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310119C

Medicare Provider Number

310119

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/14/2013

Participating Start Date

1/15/2013

Participating Approval Date

1/15/2013

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

University Hospital
Gary Huck, CFO
(973) 972-0882

Primary Contact

University Hospital
Mitch G Sobel, Director of Pharmaceutical Services
(973) 972-6258

Addresses

Street Address

90 Bergen St.
Newark, NJ 07103

Billing Address

University Hospital
150 Bergen St.
Newark, NJ 07103

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	3677001	1215998323
MD	373555900	1215998323
CT	3051703	1215998323
SC	10153A	1215998323
FL	905976800	1215998323
GA	000335497X	1215998323

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
DSH310119AA	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Gastroenterology	90 Bergen Street	Newark	NJ	Active
DSH310119AB	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Endocrinology	90 Bergen Street	Newark	NJ	Active
DSH310119AC	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Diabetes	90 Bergen Street	Newark	NJ	Active
DSH310119AD	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS Dermatology	140 Bergen Street	Newark	NJ	Active
DSH310119AE	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - PMR- Physiatry	90 Bergen Street	Newark	NJ	Active
DSH310119AF	Child	DSH	UH - UNIVERSITY HOSPITAL	Liver Transplant Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119AG	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Wellness Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119AH	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Cardiology (90 Bergen) - Cardiology	90 Bergen Street	Newark	NJ	Active
DSH310119AJ	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS Nephrology (90 Bergen) - Nephrology	90 Bergen Street	Newark	NJ	Active
DSH310119AK	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS - Hepatology (90 Bergen) - Hepatology	90 Bergen Street	Newark	NJ	Active
DSH310119AL	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - Adult Allergy/Immunology	90 Bergen Street	Newark	NJ	Active
DSH310119AM	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC Pediatric/Adolescence Clinic - Pediatric and Adolescent	90 Bergen Street	Newark	NJ	Active
DSH310119AN	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC Othopaedic Clinic - Orthopaedics	140 Bergen Street	Newark	NJ	Active
DSH310119B	Child	DSH	University Hospital	Cancer Center	205 South Orange Ave.	Newark	NJ	Terminated
DSH310119C	Child	DSH	UH - UNIVERSITY HOSPITAL	Opthalmology Serv/DOC Clinic	90 Bergen St.	Newark	NJ	Active
DSH310119D	Child	DSH	University Hospital	ACC - OBGYN	150 Bergen Street	Newark	NJ	Terminated
DSH310119E	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Infectious Disease	140 Bergen Street	Newark	NJ	Active
DSH310119F	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - OBGYN	140 Bergen Street	Newark	NJ	Active
DSH310119G	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Podiatry	140 Bergen Street	Newark	NJ	Active
DSH310119H	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Medical Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119J	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Neuro Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119K	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Pediatrics	140 Bergen Street	Newark	NJ	Terminated
DSH310119L	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Surgical Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119M	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - ENT Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119N	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Urology Clinic	140 Bergen Street	Newark	NJ	Active
DSH310119P	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - SDS	90 Bergen Street	Newark	NJ	Active
DSH310119Q	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - Imaging	90 Bergen Street	Newark	NJ	Active
DSH310119R	Child	DSH	UH - UNIVERSITY HOSPITAL	UNIVERSITY HOSPITAL / CC - Radiation Oncology	205 South Orange Ave.	NEWARK	NJ	Active
DSH310119S	Child	DSH	UH - UNIVERSITY HOSPITAL	UNIVERSITY HOSPITAL / CC - Hematology/Oncology	205 South Orange Ave.	NEWARK	NJ	Active
DSH310119T	Child	DSH	UH - UNIVERSITY HOSPITAL	UNIVERSITY HOSPITAL / CC - Infusion	205 South Orange Ave.	NEWARK	NJ	Active
DSH310119U	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Cardiology	140 Bergen Street	Newark	NJ	Active
DSH310119V	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - Neurosurgery	140 Bergen Street	Newark	NJ	Active
DSH310119W	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Rheumatology	90 Bergen Street	Newark	NJ	Active
DSH310119X	Child	DSH	UH - UNIVERSITY HOSPITAL	DOC - MSS Pulmonology	90 Bergen Street	Newark	NJ	Active
DSH310119Y	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS Nephrology	140 Bergen Street	Newark	NJ	Active
DSH310119Z	Child	DSH	UH - UNIVERSITY HOSPITAL	ACC - MSS - Hepatology	140 Bergen Street	Newark	NJ	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/24/2023 10:53:51 AM	8/26/2024 3:11:32 PM	8/26/2024 3:11 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 4:57:03 PM	8/24/2023 10:53:51 AM	8/24/2023 10:53 AM
Contacts	Primary Contact	Update	Change Request	EMONT, ANDRE PHARMACIST IN CHARGE University Hospital 9739726258	Sobel, Mitch G Director of Pharmaceutical Services University Hospital 9739726258	1/10/2023 7:51 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 10:39:16 AM	8/25/2022 4:57:03 PM	8/25/2022 4:57 PM
Contacts	Authorizing Official	Update	Profile Change Request	Huck, Gary Director, Reimbursement and Managed Care University Hospital 9739720882	Huck, Gary CFO University Hospital 9739720882	8/22/2022 7:01 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007310620019 (PA)		4/22/2022 10:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10153A	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		905976800	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000335497X	4/22/2022 10:32 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	4/22/2022 10:32 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1215998323 (PA)		4/22/2022 10:32 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1215998323	4/22/2022 10:32 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	4/22/2022 10:32 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1215998323	4/22/2022 10:32 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	4/22/2022 10:32 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1215998323	4/22/2022 10:32 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	4/22/2022 10:32 AM
Details	Last Recertification Date	Update	Recertification	9/4/2020 8:23:30 AM	8/19/2021 10:39:16 AM	8/19/2021 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007310620019	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		373555900	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3051703	9/4/2020 8:23 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/4/2020 8:23 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/4/2020 8:23 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/4/2020 8:23 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/4/2020 8:23 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/4/2020 8:23 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/4/2020 8:23 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/4/2020 8:23 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215998323	9/4/2020 8:23 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/4/2020 8:23 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1215998323 ( )		9/4/2020 8:23 AM
Contacts	Primary Contact	Update	Recertification	Huck, Gary Director, Reimbursement and Managed Care University Hospital 9739720882	EMONT, ANDRE PHARMACIST IN CHARGE University Hospital 9739726258	9/4/2020 8:23 AM
Details	Last Recertification Date	Update	Recertification	9/10/2019 12:14:40 PM	9/4/2020 8:23:30 AM	9/4/2020 8:23 AM
Contacts	Authorizing Official	Update	AO Change Request	Daly, Thomas VP & CFO University Hospital 9739723721	Huck, Gary Director, Reimbursement and Managed Care University Hospital 9739720882	12/16/2019 10:56 AM
Addresses	Billing Address	Update	Recertification	UMDNJ - University Hospital 150 Bergen St. Newark, NJ 07103	University Hospital 150 Bergen St. Newark, NJ 07103	9/10/2019 12:14 PM
Details	Last Recertification Date	Update	Recertification	9/7/2018 12:23:31 PM	9/10/2019 12:14:40 PM	9/10/2019 12:14 PM
Details	Last Recertification Date	Update	Recertification	11/20/2017 11:19:39 AM	9/7/2018 12:23:31 PM	9/7/2018 12:23 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/20/2017 11:19:39 AM	11/20/2017 11:19 AM
Contacts	Authorizing Official	Update		Daly, Thomas VP & CFO 9739723721	Daly, Thomas VP & CFO University Hospital 9739723721	10/18/2017 4:20 PM
Contacts	Primary Contact	Update		Huck, Gary Director, Reimbursement and Managed Care 9739720882	Huck, Gary Director, Reimbursement and Managed Care University Hospital 9739720882	9/27/2017 10:31 AM
Contacts	Primary Contact	Update		Huck, Gary Director, Managed Care and Reimbursement 9739720882	Huck, Gary Director, Reimbursement and Managed Care 9739720882	3/3/2017 4:46 PM
Contacts	Authorizing Official	Insert			Daly, Thomas VP & CFO 9739723721	3/3/2017 4:46 PM
Addresses	Main Address	Insert			90 Bergen St. Newark, NJ 07103	3/3/2017 4:46 PM
Addresses	Billing Address	Insert			UMDNJ - University Hospital 150 Bergen St. Newark, NJ 07103	3/3/2017 4:46 PM
Contacts	Signed By	Insert			Daly, Thomas VP and CFO 9739723721	3/3/2017 4:46 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 12:33 PM
Details	Entity Name	Update		University Hospital	UH - UNIVERSITY HOSPITAL	8/3/2016 11:08 AM
Details	Last Recertification Date	Update		8/19/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 3:55 PM
Details	Last Recertification Date	Update		8/22/2013 12:00:00 AM	8/19/2014 12:00:00 AM	8/19/2014 11:42 AM
Details	Entity Name	Update		UMDNJ UNIVERSITY HOSPITAL	University Hospital	12/2/2013 11:44 AM
Details	Last Recertification Date	Update			8/22/2013 12:00:00 AM	8/22/2013 5:31 AM
Contacts	Primary Contact	Insert			Huck, Gary Director, Managed Care and Reimbursement 9739720882	1/16/2013 3:59 PM
Details	340B ID	Update		ISAPDSH310119C	DSH310119C	1/15/2013 3:43 PM
Dates	Participating Approval Date	Update			1/15/2013 12:00:00 AM	1/15/2013 3:43 PM
Details	State	Update		Pending	Active	1/15/2013 3:43 PM
Dates	Start Date	Update			1/15/2013 12:00:00 AM	1/15/2013 3:43 PM
Details	Entity Subname	Update		DOC	Opthalmology Serv/DOC Clinic	1/15/2013 2:40 PM
Details	340B ID	Update		AP011513L	ISAPDSH310119C	1/15/2013 1:44 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	AP011513L	1/15/2013 8:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/14/2013 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			3677001	1/14/2013 4:51 PM
Medicaid Billing	Medicaid: State	Insert			NJ	1/14/2013 4:51 PM
Medicaid Billing	NPI: Number	Insert			1215998323	1/14/2013 4:51 PM
Details	Last Recertification Date	Insert				1/14/2013 4:51 PM
Details	Grant Number	Insert				1/14/2013 4:51 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/14/2013 4:51 PM
Details	Is Authorizing Official EHB Data	Insert				1/14/2013 4:51 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2013 4:51 PM
Details	Medicare Provider Number	Insert			310119	1/14/2013 4:51 PM
Details	Entity Name	Insert			UMDNJ UNIVERSITY HOSPITAL	1/14/2013 4:51 PM
Details	Program Code	Insert			DSH	1/14/2013 4:51 PM
Details	Entity Subname	Insert			DOC	1/14/2013 4:51 PM
Dates	Participating Approval Date	Insert				1/14/2013 4:51 PM
Details	State	Insert			Pending	1/14/2013 4:51 PM
Dates	Registration Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 4:51 PM
Dates	Signed By Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 4:51 PM
Dates	Start Date	Insert				1/14/2013 4:51 PM
Terminations	Termination Comments	Insert				1/14/2013 4:51 PM
Terminations	Termination Date	Insert				1/14/2013 4:51 PM
Terminations	Termination Effective Date	Insert				1/14/2013 4:51 PM
Terminations	Termination Reason	Insert				1/14/2013 4:51 PM