Covered Entity Details

DSH330055U NEWYORK-PRESBYTERIAN / QUEENS (Active) - information as of 4/25/2025 5:39:25 PM

Main Details

Name

NEWYORK-PRESBYTERIAN / QUEENS

Subdivision Name

NYP/Queens Pediatric Asthma Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330055U

Medicare Provider Number

330055

Outpatient Facility Provider Number

330055

Additional Details

Current Program Status

Active

Registration Date

10/8/2013

Participating Start Date

1/1/2014

Participating Approval Date

11/3/2013

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

New York Presbyterian
William Farrell, SVP, Finance
(212) 297-4358

Primary Contact

NewYork-Presbyterian Hospital
Gajendra Gharia, Director of Finance, Dept of 340B Programs
(212) 297-4353

Addresses

Street Address

59-16 174th Street
Fresh Meadows, NY 11365

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	4157109	1952347205
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
Contract Detail	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	01/11/2019	04/01/2019	04/01/2019	02/01/2023	11/10/2023
Contract Detail	TOTAL CARE RX, INC.	WORLD'S FAIR PHARMACY	22310 UNION TPKE	OAKLAND GARDENS	NY	11364-3645	01/11/2019	04/01/2019			03/30/2024

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	Last Recertification Date	Update	Recertification	8/30/2023 1:31:43 PM	8/23/2024 2:50:59 PM	8/23/2024 2:50 PM
Addresses	Main Address	Update	Change Request	59-16 174th Street Flushing, NY 11365	59-16 174th Street Fresh Meadows, NY 11365	6/5/2024 8:44 AM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:23:58 PM	8/30/2023 1:31:43 PM	8/30/2023 1:31 PM
Contacts	Primary Contact	Update	Recertification	Wilkin, Kevin Paul Pharmacy Director New York Presbyterian Queens 7186702894	Gharia, Gajendra Director of Finance, Dept of 340B Programs NewYork-Presbyterian Hospital 2122974353	9/6/2022 12:23 PM
Details	Last Recertification Date	Update	Recertification	9/1/2021 12:21:32 PM	9/6/2022 12:23:58 PM	9/6/2022 12:23 PM
Contacts	Authorizing Official	Update	Change Request	Ward, Kevin Senior VP FOR FINANCE NY Presbyterian/Queens 7186701476	Farrell, William SVP, Finance New York Presbyterian 2122974358	6/21/2022 6:46 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 12:13:00 PM	9/1/2021 12:21:32 PM	9/1/2021 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 12:13 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4157109	9/9/2020 12:13 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/9/2020 12:13 PM
Medicaid Billing	NPI: State	Update	Recertification		NJ	9/9/2020 12:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1952347205	9/9/2020 12:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/9/2020 12:13 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 5:59:32 PM	9/9/2020 12:13:00 PM	9/9/2020 12:13 PM
Contacts	Primary Contact	Update	Change Request	Melchert, Alexander Director of Pharmacy NewYork-Presbyterian-Queens 7186701545	Wilkin, Kevin Paul Pharmacy Director New York Presbyterian Queens 7186702894	9/12/2019 4:38 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 12:40:19 PM	8/20/2019 5:59:32 PM	8/20/2019 5:59 PM
Details	Last Recertification Date	Update	Recertification	11/27/2017 11:42:39 AM	8/17/2018 12:40:19 PM	8/17/2018 12:40 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	00244133	02998992	2/6/2018 6:21 PM
Medicaid Billing	NPI: Number	Update	Change Request	1053429274	1952347205	2/6/2018 6:21 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 11:42:39 AM	11/27/2017 11:42 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			59-16 174th Street Flushing, NY 11365	5/5/2017 11:58 AM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 10:20 AM
Details	Entity Subname	Update		Pediatric Asthma Center	NYP/Queens Pediatric Asthma Center	9/1/2016 10:20 AM
Details	Entity Name	Update		THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS	NewYork-Presbyterian / Queens	11/13/2015 3:53 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
Details	340B ID	Update		DSH330055S	DSH330055U	11/3/2013 9:14 PM
Dates	Participating Approval Date	Update			11/3/2013 12:00:00 AM	11/3/2013 9:14 PM
Details	State	Update		Pending	Active	11/3/2013 9:14 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	11/3/2013 9:14 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH330055S	10/29/2013 8:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/8/2013 11:23 AM
Medicaid Billing	Medicaid: Number	Insert			00244133	10/8/2013 11:23 AM
Medicaid Billing	Medicaid: State	Insert			NY	10/8/2013 11:23 AM
Medicaid Billing	NPI: Number	Insert			1053429274	10/8/2013 11:23 AM
Details	Last Recertification Date	Insert				10/8/2013 11:23 AM
Details	Grant Number	Insert				10/8/2013 11:23 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/8/2013 11:23 AM
Details	Is Authorizing Official EHB Data	Insert				10/8/2013 11:23 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/8/2013 11:23 AM
Details	Medicare Provider Number	Insert			330055	10/8/2013 11:23 AM
Details	Entity Name	Insert			THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS	10/8/2013 11:23 AM
Details	Program Code	Insert			DSH	10/8/2013 11:23 AM
Details	Entity Subname	Insert			Pediatric Asthma Center	10/8/2013 11:23 AM
Dates	Participating Approval Date	Insert				10/8/2013 11:23 AM
Details	State	Insert			Pending	10/8/2013 11:23 AM
Dates	Registration Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 11:23 AM
Dates	Signed By Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 11:23 AM
Dates	Start Date	Insert				10/8/2013 11:23 AM
Terminations	Termination Comments	Insert				10/8/2013 11:23 AM
Terminations	Termination Date	Insert				10/8/2013 11:23 AM
Terminations	Termination Effective Date	Insert				10/8/2013 11:23 AM
Terminations	Termination Reason	Insert				10/8/2013 11:23 AM