Covered Entity Details

DSH330055C NEWYORK-PRESBYTERIAN / QUEENS (Terminated) - information as of 4/27/2025 1:51:15 AM

Main Details

Name

NEWYORK-PRESBYTERIAN / QUEENS

Subdivision Name

NYP / Queens Hollis Women's Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330055C

Medicare Provider Number

330055

Outpatient Facility Provider Number

330055

Additional Details

Current Program Status

Terminated

Registration Date

10/7/2013

Participating Start Date

1/1/2014

Participating Approval Date

11/3/2013

Last Recertification Date

11/27/2017

Termination Date
Termination Reason

7/1/2018
Business decision by the Covered Entity

Contacts

Authorizing Official

NY Presbyterian/Queens
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476

Primary Contact

NewYork-Presbyterian-Queens
Alexander Melchert, Director of Pharmacy
(718) 670-1545

Addresses

Street Address

189-02 Hillside Avenue
Hollis, NY 11423

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	02998992
		1952347205

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
DSH330055A	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Center For Developmental Disability and NeuroScience Center	59-16 174th Street	Flushing	NY	Active
DSH330055B	Child	DSH	NewYork-Presbyterian / Queens	Family Health Center	136-56 39th Avenue	Flushing	NY	Terminated
DSH330055C	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP / Queens Hollis Women's Center	189-02 Hillside Avenue	Hollis	NY	Terminated
DSH330055D	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Family Health Center	73-15 Northern Blvd	Jackson Heights	NY	Terminated
DSH330055E	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Eye Care Center	174-15 Horace Harding Expressway	Fresh Meadows	NY	Active
DSH330055F	Child	DSH	NewYork-Presbyterian / Queens	NYP/ Queens Medical Extension Clinic / Ambulatory Care Center	182-15 Horace Harding Expressway	Fresh Meadows	NY	Terminated
DSH330055G	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Obstetrics Center	163-03 Horace Harding Expressway	Fresh Meadows	NY	Active
DSH330055H	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Primary Care Center	182-19 Horace Harding Expressway	Fresh Meadows	NY	Active
DSH330055J	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Cardiac Health Center	174-11 Horace Harding Expressway	Fresh Meadows	NY	Terminated
DSH330055K	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Special Care Center	138-47 Horace Harding Expressway	Flushing	NY	ToBeTerminated
DSH330055L	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	The Breast Center	56-26 Main Street	Flushing	NY	Terminated
DSH330055N	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Dental Services Center	174-11 Horace Harding Expressway	Fresh Meadows	NY	Active
DSH330055P	Child	DSH	NewYork-Presbyterian / Queens	NYHQ Ambulance Service	56-45 Main Street	Flushing	NY	Terminated
DSH330055Q	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Trude Weishaupt Memorial Satellite Dialysis Center	59-28 174th Street	Fresh Meadows	NY	Active
DSH330055R	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Wound Healing Center	144-45 87th Avenue	Briarwood	NY	Active
DSH330055T	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	Employee Health Services	139-09 58th Street	Flushing	NY	Terminated
DSH330055U	Child	DSH	NEWYORK-PRESBYTERIAN / QUEENS	NYP/Queens Pediatric Asthma Center	59-16 174th Street	Fresh Meadows	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		3/1/2018 12:00:00 AM	6/4/2018 2:01 PM
Details	State	Update	Termination Request	Active	To Be Terminated	6/4/2018 2:01 PM
Terminations	Termination Date	Update	Termination Request		7/1/2018 12:00:00 AM	6/4/2018 2:01 PM
Terminations	Termination Effective Date	Update	Termination Request		5/14/2018 12:00:00 AM	6/4/2018 2:01 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	6/4/2018 2:01 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	00244133	02998992	2/6/2018 6:20 PM
Details	Entity Name	Update	Recertification	NewYork-Presbyterian / Queens	NEWYORK-PRESBYTERIAN / QUEENS	11/29/2017 7:48 PM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/27/2017 11:36:59 AM	11/27/2017 11:36 AM
Contacts	Authorizing Official	Update		Ward, Kevin Senior VP FOR FINANCE 7186701476	Ward, Kevin Senior VP FOR FINANCE NY Presbyterian/Queens 7186701476	10/30/2017 1:21 PM
Contacts	Primary Contact	Update		Melchert, Alexander Director of Pharmacy 7186701545	Melchert, Alexander Director of Pharmacy NewYork-Presbyterian-Queens 7186701545	10/4/2017 8:28 AM
Contacts	Authorizing Official	Insert			Ward, Kevin Senior VP FOR FINANCE 7186701476	7/5/2017 3:43 PM
Contacts	Signed By	Insert			HAGAN, FRANCIS VP FOR FINANCE 7186701971	5/5/2017 11:58 AM
Contacts	Primary Contact	Insert			Melchert, Alexander Director of Pharmacy 7186701545	5/5/2017 11:58 AM
Addresses	Main Address	Insert			189-02 Hillside Avenue Hollis, NY 11423	5/5/2017 11:57 AM
Details	Entity Subname	Update		NYP / Hollis Women's Center	NYP / Queens Hollis Women's Center	5/5/2017 11:57 AM
Details	Entity Subname	Update		Hollis Women's Center	NYP / Hollis Women's Center	12/12/2016 7:09 AM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 10:19 AM
Details	Entity Name	Update		THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS	NewYork-Presbyterian / Queens	11/13/2015 3:54 PM
Details	Last Recertification Date	Update		9/9/2014 12:00:00 AM	8/31/2015 12:00:00 AM	8/31/2015 2:46 PM
Details	Last Recertification Date	Update			9/9/2014 12:00:00 AM	9/9/2014 10:00 AM
Dates	Participating Approval Date	Update			11/3/2013 12:00:00 AM	11/3/2013 9:36 PM
Details	State	Update		Pending	Active	11/3/2013 9:36 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	11/3/2013 9:36 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH330055C	10/29/2013 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/7/2013 3:38 PM
Medicaid Billing	Medicaid: Number	Insert			00244133	10/7/2013 3:38 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/7/2013 3:38 PM
Medicaid Billing	NPI: Number	Insert			1952347205	10/7/2013 3:38 PM
Details	Last Recertification Date	Insert				10/7/2013 3:38 PM
Details	Grant Number	Insert				10/7/2013 3:38 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/7/2013 3:38 PM
Details	Is Authorizing Official EHB Data	Insert				10/7/2013 3:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/7/2013 3:38 PM
Details	Medicare Provider Number	Insert			330055	10/7/2013 3:38 PM
Details	Entity Name	Insert			THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS	10/7/2013 3:38 PM
Details	Program Code	Insert			DSH	10/7/2013 3:38 PM
Details	Entity Subname	Insert			Hollis Women's Center	10/7/2013 3:38 PM
Dates	Participating Approval Date	Insert				10/7/2013 3:38 PM
Details	State	Insert			Pending	10/7/2013 3:38 PM
Dates	Registration Date	Insert			10/7/2013 12:00:00 AM	10/7/2013 3:38 PM
Dates	Signed By Date	Insert			10/7/2013 12:00:00 AM	10/7/2013 3:38 PM
Dates	Start Date	Insert				10/7/2013 3:38 PM
Terminations	Termination Comments	Insert				10/7/2013 3:38 PM
Terminations	Termination Date	Insert				10/7/2013 3:38 PM
Terminations	Termination Effective Date	Insert				10/7/2013 3:38 PM
Terminations	Termination Reason	Insert				10/7/2013 3:38 PM