Covered Entity Details

DSH330234E WESTCHESTER MEDICAL CENTER (Active) - information as of 4/29/2025 1:41:19 AM

Main Details

Name

WESTCHESTER MEDICAL CENTER

Subdivision Name

WMC Behavioral Health Center: Mental Health Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330234E

Medicare Provider Number

330234

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2013

Participating Start Date

1/1/2014

Participating Approval Date

12/6/2013

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Westchester Medical Center
Anthony Costello, COO
(914) 493-7028

Primary Contact

Westchester Medical Center
Varghese Thankachen, Network Director of Pharmacy Business Operations
(914) 493-7205

Addresses

Street Address

20 HOSPITAL ROAD
Valhalla, NY 10595

Billing Address

WESTCHESTER MEDICAL CENTER
100 Woods Road
VALHALLA, NY 10595

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	00274213	1932280666
CT	003108992	1932280666
NJ	4159608	1932280666

Shipping Addresses

Shipping Address 1

Westchester Medical Center
100 Woods Road
Valhalla, NY 10595

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
DSH330234A	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Hematotherapy Clinic -Blood Storing, Processing & Transfusion	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234AA	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Turning Point	241 North Road	Poughkeepsie	NY	Terminated
DSH330234AB	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Recovery Room	241 North Road	Poughkeepsie	NY	Active
DSH330234AD	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Radiology	241 North Road	Poughkeepsie	NY	Active
DSH330234AE	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: RadioIsotopes	241 North Road	Poughkeepsie	NY	Terminated
DSH330234AF	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Respiratory Therapy	241 North Road	Poughkeepsie	NY	Active
DSH330234AG	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Ultrasound	241 North Road	Poughkeepsie	NY	Active
DSH330234AH	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Woundcare/Hyperbaric	1 Webster Avenue	Poughkeepsie	NY	Active
DSH330234AJ	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital - Observation Beds	241 North Road	Poughkeepsie	NY	Active
DSH330234AK	Child	DSH	WESTCHESTER MEDICAL CENTER	DENTISTRY CLINIC - MACY PAVILION	100 Woods Road	VALHALLA	NY	Terminated
DSH330234AL	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Ophthalmology Clinic SUITE 600	19 Bradhurst	Hawthorne	NY	Active
DSH330234AM	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Children's Clinic - Pediatric - Suite #550	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234AN	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Cancer Center - Outpatient Infusion Center	19 Bradhurst Avenue	Hawthorne	NY	Active
DSH330234AP	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC HEART AND VASCULAR IMAGING CENTER - RADIOLOGY - IMAGING	19 BRADHURST AVE	Hawthorne	NY	Terminated
DSH330234B	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Pulmonary Function Testing	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234C	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Adult Clinic - Suite #700	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234D	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: HIV-AIDS Ally Clinic - Suite #600	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234E	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Behavioral Health Center: Mental Health Clinic	20 HOSPITAL ROAD	Valhalla	NY	Active
DSH330234F	Child	DSH	WESTCHESTER MEDICAL CENTER	Referred Ambulatory Services	19 BRADHURST AVE	HAWTHORNE	NY	Terminated
DSH330234G	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Advanced Imaging - Suite 1000	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234H	Child	DSH	WESTCHESTER MEDICAL CENTER	Speech Pathology	19 Bradhurst Ave.	Hawthorne	NY	Terminated
DSH330234K	Child	DSH	Westchester Medical Center	MidHudson Regional Hospital: 6 Cooke	241 North Road	Poughkeepsie	NY	Terminated
DSH330234L	Child	DSH	Westchester Medical Center	MidHudson Regional Hospital: Alcohol Rehab	241 North Road	Poughkeepsie	NY	Terminated
DSH330234M	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Atrium Surgery Center	1 Webster Avenue	Poughkeepsie	NY	Active
DSH330234N	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Cardiac Cath Lab	241 North Road	Poughkeepsie	NY	Active
DSH330234P	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Cardiology	241 North Road	Poughkeepsie	NY	Active
DSH330234R	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Clinic	1 Webster Avenue	Poughkeepsie	NY	Terminated
DSH330234S	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: CT Scan	241 North Road	Poughkeepsie	NY	Active
DSH330234T	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Interventional Radiology	241 North Road	Poughkeepsie	NY	Active
DSH330234U	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: EEG	241 North Road	Poughkeepsie	NY	Active
DSH330234V	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Emergency Dept	241 North Road	Poughkeepsie	NY	Active
DSH330234W	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Wellness Center	241 North Road	Poughkeepsie	NY	Terminated
DSH330234Y	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Infusion Center	19 Baker Avenue	Poughkeepsie	NY	Active
DSH330234Z	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Operating Room	241 North Road	Poughkeepsie	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 2:42:32 PM	8/29/2024 3:04:14 PM	8/29/2024 3:04 PM
Addresses	Shipping Address	Insert	Recertification		Westchester Medical Center 100 Woods Road Valhalla, NY 10595	9/5/2023 2:42 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 1:28:27 PM	9/5/2023 2:42:32 PM	9/5/2023 2:42 PM
Contacts	Primary Contact	Update	Profile Change Request	Thankachen, Varghese Director of Pharmacy Westchester Medical Center 9144937205	Thankachen, Varghese Network Director of Pharmacy Business Operations Westchester Medical Center 9144937205	7/13/2023 9:45 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 10:17:07 AM	9/13/2022 1:28:27 PM	9/13/2022 1:28 PM
Details	Last Recertification Date	Update	Recertification	9/14/2020 6:51:00 AM	9/10/2021 10:17:07 AM	9/10/2021 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:51 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003108992	9/14/2020 6:51 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/14/2020 6:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:51 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4159608	9/14/2020 6:51 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/14/2020 6:51 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1932280666 ( )		9/14/2020 6:51 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/14/2020 6:51 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/14/2020 6:51 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/14/2020 6:51 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/14/2020 6:51 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/14/2020 6:51 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/14/2020 6:51 AM
Details	Last Recertification Date	Update	Recertification	9/11/2019 4:30:53 PM	9/14/2020 6:51:00 AM	9/14/2020 6:51 AM
Details	Entity Subname	Update	Recertification	Mental Health Clinic	WMC Behavioral Health Center: Mental Health Clinic	9/14/2020 6:51 AM
Contacts	Authorizing Official	Update	Change Request	Esses, Allen Chief Supply Chain Officer Westchester Medical Center 9144936543	Costello, Anthony COO Westchester Medical Center 9144937028	3/6/2020 12:35 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 1:10:42 PM	9/11/2019 4:30:53 PM	9/11/2019 4:30 PM
Details	Last Recertification Date	Update	Recertification	12/4/2017 11:52:47 AM	8/28/2018 1:10:42 PM	8/28/2018 1:10 PM
Addresses	Billing Address	Insert	Change Request		WESTCHESTER MEDICAL CENTER 100 Woods Road VALHALLA, NY 10595	3/2/2018 11:21 AM
Addresses	Main Address	Update	Change Request	100 Woods Road Valhalla, NY 10595	20 HOSPITAL ROAD Valhalla, NY 10595	3/2/2018 11:21 AM
Contacts	Primary Contact	Update	Recertification	County, Anthony Pharmacy Project Lead 9144937102	Thankachen, Varghese Director of Pharmacy Westchester Medical Center 9144937205	12/4/2017 11:52 AM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	12/4/2017 11:52:47 AM	12/4/2017 11:52 AM
Contacts	Authorizing Official	Insert	AO Change Request		Esses, Allen Chief Supply Chain Officer Westchester Medical Center 9144936543	11/29/2017 10:57 AM
Contacts	Primary Contact	Update		County, Anthony Director of Pharmacy 9144937205	County, Anthony Pharmacy Project Lead 9144937102	8/16/2016 5:12 PM
Contacts	Signed By	Insert			Casey, Marsha Executive Vice President 9144937028	8/16/2016 5:12 PM
Addresses	Main Address	Insert			100 Woods Road Valhalla, NY 10595	8/16/2016 8:20 AM
Details	Last Recertification Date	Update		9/4/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 8:20 AM
Contacts	Primary Contact	Insert			County, Anthony Director of Pharmacy 9144937205	8/16/2016 8:18 AM
Details	Last Recertification Date	Update		9/10/2014 12:00:00 AM	9/4/2015 12:00:00 AM	9/4/2015 2:40 PM
Details	Last Recertification Date	Update			9/10/2014 12:00:00 AM	9/10/2014 6:56 AM
Dates	Participating Approval Date	Update			12/6/2013 12:00:00 AM	12/6/2013 12:47 PM
Details	State	Update		Pending	Active	12/6/2013 12:47 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	12/6/2013 12:47 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH330234E	12/3/2013 3:15 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/9/2013 1:15 PM
Medicaid Billing	Medicaid: Number	Insert			00274213	10/9/2013 1:15 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/9/2013 1:15 PM
Medicaid Billing	NPI: Number	Insert			1932280666	10/9/2013 1:15 PM
Details	Last Recertification Date	Insert				10/9/2013 1:15 PM
Details	Grant Number	Insert				10/9/2013 1:15 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/9/2013 1:15 PM
Details	Is Authorizing Official EHB Data	Insert				10/9/2013 1:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/9/2013 1:15 PM
Details	Medicare Provider Number	Insert			330234	10/9/2013 1:15 PM
Details	Entity Name	Insert			WESTCHESTER MEDICAL CENTER	10/9/2013 1:15 PM
Details	Program Code	Insert			DSH	10/9/2013 1:15 PM
Details	Entity Subname	Insert			Mental Health Clinic	10/9/2013 1:15 PM
Dates	Participating Approval Date	Insert				10/9/2013 1:15 PM
Details	State	Insert			Pending	10/9/2013 1:15 PM
Dates	Registration Date	Insert			10/9/2013 12:00:00 AM	10/9/2013 1:15 PM
Dates	Signed By Date	Insert			10/9/2013 12:00:00 AM	10/9/2013 1:15 PM
Dates	Start Date	Insert				10/9/2013 1:15 PM
Terminations	Termination Comments	Insert				10/9/2013 1:15 PM
Terminations	Termination Date	Insert				10/9/2013 1:15 PM
Terminations	Termination Effective Date	Insert				10/9/2013 1:15 PM
Terminations	Termination Reason	Insert				10/9/2013 1:15 PM