Covered Entity Details

DSH330236F NewYork-Presbyterian/Brooklyn Methodist (Terminated) - information as of 4/29/2025 1:41:23 AM

Main Details

Name

NewYork-Presbyterian/Brooklyn Methodist

Subdivision Name

Pulmonary Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330236F

Medicare Provider Number

330236

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/8/2013

Participating Start Date

1/1/2014

Participating Approval Date

11/17/2013

Last Recertification Date

9/5/2016

Termination Date
Termination Reason

1/1/2018
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

NewYork Presbyterian Brooklyn Methodist Hospital
Michael P. Fagan, Senior VP of Finance
(718) 780-3031

Primary Contact

Michael Orsini, Interim Chief/ Supervising Pharmacist
(718) 780-5575 Ext: 5569

Addresses

Street Address

501 Sixth Street
Room 7A
Brooklyn, NY 11215

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	02998805
		1548374549

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
DSH330236E	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Foot and Ankle Center	1 Prospect Park West	Brooklyn	NY	Terminated
DSH330236F	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Pulmonary Center	501 Sixth Street	Brooklyn	NY	Terminated
DSH330236H	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Dental Medicine	506 sixth Street	Brooklyn	NY	Terminated
DSH330236J	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Bay Ridge Nuclear Cardiology	8721 5th Avenue	Brooklyn	NY	Terminated
DSH330236M	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Out-Patient Physcian Services- Clinic Admin	506 sixth Street 6th FL	Brooklyn	NY	Terminated
DSH330236P	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Pediatric Clinic	263 7th Avenue	Brooklyn	NY	Terminated
DSH330236T	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Surgical Clinic	506 sixth Street	Brooklyn	NY	Terminated
DSH330236U	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	OB/GYN Womens Health Clinic	263 7th Avenue	Brooklyn	NY	Terminated
DSH330236V	Child	DSH	NewYork-Presbyterian/Brooklyn Methodist	Ambulatory Infusion Center	343 4th Avenue	Brooklyn	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		3/7/2017 12:00:00 AM	11/29/2017 7:50 PM
Details	State	Update	Recertification	Active	To Be Terminated	11/29/2017 7:50 PM
Terminations	Termination Comments	Update	Recertification		as part of our annual recertification we are clarifying changes to 340B database	11/29/2017 7:50 PM
Terminations	Termination Date	Update	Recertification		1/1/2018 12:00:00 AM	11/29/2017 7:50 PM
Terminations	Termination Effective Date	Update	Recertification		3/7/2017 12:00:00 AM	11/29/2017 7:50 PM
Terminations	Termination Reason	Update	Recertification		Hospital Outpatient facility no longer eligible	11/29/2017 7:50 PM
Contacts	Authorizing Official	Update		Fagan, Michael P. Senior VP of Finance 7187803031	Fagan, Michael P. Senior VP of Finance NewYork Presbyterian Brooklyn Methodist Hospital 7187803031	11/10/2017 10:13 AM
Contacts	Authorizing Official	Insert			Fagan, Michael P. Senior VP of Finance 7187803031	7/19/2017 9:43 AM
Contacts	Primary Contact	Update		Balmir, Eric Chief of Pharmacy 7187805575-5569	Orsini, Michael Interim Chief/ Supervising Pharmacist 7187805575-5569	3/13/2017 12:19 PM
Contacts	Signed By	Insert			ZAIDBERG, EDWARD SR VP OF FINANCE 7187803031	3/13/2017 12:18 PM
Addresses	Main Address	Insert			501 Sixth Street Room 7A Brooklyn, NY 11215	3/13/2017 12:17 PM
Details	Entity Name	Update		NEW YORK METHODIST HOSPITAL	NewYork-Presbyterian/Brooklyn Methodist	3/13/2017 12:17 PM
Contacts	Primary Contact	Insert			Balmir, Eric Chief of Pharmacy 7187805575-5569	9/5/2016 9:23 AM
Details	Last Recertification Date	Update		9/5/2015 12:00:00 AM	9/5/2016 12:00:00 AM	9/5/2016 9:23 AM
Details	Entity Subname	Update		Pulmonary & Critical Care	Pulmonary Center	9/5/2016 9:23 AM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	9/5/2015 12:00:00 AM	9/5/2015 7:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/20/2014 2:04 PM
Medicaid Billing	Medicaid: Number	Insert			02998805	8/20/2014 2:04 PM
Medicaid Billing	Medicaid: State	Insert			NY	8/20/2014 2:04 PM
Medicaid Billing	NPI: Number	Insert			1548374549	8/20/2014 2:04 PM
Details	Last Recertification Date	Update			8/20/2014 12:00:00 AM	8/20/2014 2:04 PM
Dates	Participating Approval Date	Update			11/17/2013 12:00:00 AM	11/17/2013 7:31 AM
Details	State	Update		Pending	Active	11/17/2013 7:31 AM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	11/17/2013 7:31 AM
Details	340B ID	Update		DSH330236Waiting	DSH330236F	11/12/2013 8:33 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH330236Waiting	10/24/2013 4:17 PM
Details	Last Recertification Date	Insert				10/8/2013 3:49 PM
Details	Grant Number	Insert				10/8/2013 3:49 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/8/2013 3:49 PM
Details	Is Authorizing Official EHB Data	Insert				10/8/2013 3:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/8/2013 3:49 PM
Details	Medicare Provider Number	Insert			330236	10/8/2013 3:49 PM
Details	Entity Name	Insert			NEW YORK METHODIST HOSPITAL	10/8/2013 3:49 PM
Details	Program Code	Insert			DSH	10/8/2013 3:49 PM
Details	Entity Subname	Insert			Pulmonary & Critical Care	10/8/2013 3:49 PM
Dates	Participating Approval Date	Insert				10/8/2013 3:49 PM
Details	State	Insert			Pending	10/8/2013 3:49 PM
Dates	Registration Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 3:49 PM
Dates	Signed By Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 3:49 PM
Dates	Start Date	Insert				10/8/2013 3:49 PM
Terminations	Termination Comments	Insert				10/8/2013 3:49 PM
Terminations	Termination Date	Insert				10/8/2013 3:49 PM
Terminations	Termination Effective Date	Insert				10/8/2013 3:49 PM
Terminations	Termination Reason	Insert				10/8/2013 3:49 PM