Covered Entity Details

DSH330394BG UNITED HEALTH SERVICES HOSPITALS, INC. (Active) - information as of 4/24/2025 11:59:08 PM

Main Details

Name

UNITED HEALTH SERVICES HOSPITALS, INC.

Subdivision Name

UHS VESTAL-BREAST CARE CENTER

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330394BG

Medicare Provider Number

330394

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2013

Participating Start Date

1/1/2014

Participating Approval Date

12/9/2013

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

United Health Services Hospitals, Inc.
James Mark Smith, Vice President - Chief Financial Officer
(607) 762-3011

Primary Contact

United Health Services Hospitals, Inc
Ryan C. Decaro, Pharmacy Business Manager
(607) 763-1838

Addresses

Street Address

4417 Vestal Parkway
Vestal, NY 13850

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		1518998699

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
DSH330394A	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	WILSON MEMORIAL REGIONAL MEDICAL CENTER	33-57 HARRISON STREET	JOHNSON CITY	NY	Terminated
DSH330394AA	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-PEDIATRICS	4417 Vestal Parkway	Vestal	NY	Active
DSH330394AB	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-CARDIOLOGY	4417 Vestal Parkway	Vestal	NY	Active
DSH330394AC	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-GYN	4417 Vestal Parkway	Vestal	NY	Active
DSH330394AD	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-FAMILY PRACTICE	4417 Vestal Parkway	Vestal	NY	Active
DSH330394AF	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS COMPREHENSIVE ORTHOPEDIC CENTER-RHEUMATOLOGY	4433 Vestal Parkway East	Vestal	NY	Active
DSH330394AH	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS 1302 E MAIN ST ENDICOTT-WALK IN	1302 Main Street	Endicott	NY	Active
DSH330394AJ	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS 1302 E MAIN ST ENDICOTT- FAMILY PRACTICE	1302 Main Street	Endicott	NY	Active
DSH330394AK	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PR CARE ENDWELL-INTERNAL MEDICINE	800 Hooper Road	Endwell	NY	Active
DSH330394AL	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS Primary Care Endwell - Pulmonology	800 Hooper Road	Endwell	NY	Terminated
DSH330394AM	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON SQ-UROLOGY	30 Harrison Street	Johnson City	NY	Active
DSH330394AN	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON SQ-OTOLARYNGOLOGY	30 Harrison Street	Johnson City	NY	Active
DSH330394AP	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON SQ-OBGYN	30 Harrison Street	Johnson City	NY	Active
DSH330394AQ	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON SQ-SURGERY	30 Harrison Street	Johnson City	NY	Active
DSH330394AR	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON SQ-GERIATRICS	507 Main Street	Johnson City	NY	Active
DSH330394AS	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS Wilson Square - Cardiothoracic	30 Harrison Street	Johnson City	NY	Terminated
DSH330394AT	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS Wilson Square - Infectious Disease	30 Harrison Street	Johnson City	NY	Terminated
DSH330394AU	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS COMPREHENSIVE ORTHOPEDIC CENTER-ORTHOPEDICS	4433 Vestal Parkway East	Vestal	NY	Active
DSH330394AV	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS Medical Group Orthopedics - Internal Medicine	33 Mitchell Avenue	Binghamton	NY	Terminated
DSH330394AW	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-INFECTIOUS DISEASE	4417 Vestal Parkway East	Vestal	NY	Active
DSH330394AX	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS COMPREHENSIVE ORTHOPEDIC CENTER-PODIATRY	4433 Vestal Parkway East	Vestal	NY	Active
DSH330394AY	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS FRONT ST VESTAL-DERMATOLOGY	200 Front Street	Vestal	NY	Active
DSH330394AZ	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE JOHNSON CITY-FAMILY PRACTICE	507 Main Street	Johnson City	NY	Active
DSH330394B	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	BINGHAMTON GENERAL HOSPITAL	10-42 MITCHELL AVENUE	BINGHAMTON	NY	Terminated
DSH330394BA	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS Primary Care Upper Front Street - Internal Medicine	1290 Upper Front Street	Binghamton	NY	Terminated
DSH330394BB	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE UPPER FRONT ST CB-FAMILY PRACTICE	1290 Upper Front Street	Binghamton	NY	Active
DSH330394BC	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE GREENE-FAMILY PRACTICE	15 Birdsall Street	Greene	NY	Active
DSH330394BD	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE 42 W MAIN ST OWEGO-FAMILY PRACTICE	42 West Main Street	Owego	NY	Active
DSH330394BE	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-WALK IN	4417 Vestal Parkway	Vestal	NY	Active
DSH330394BF	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-BREAST SURGERY	4417 Vestal Parkway	Vestal	NY	Active
DSH330394BG	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS VESTAL-BREAST CARE CENTER	4417 Vestal Parkway	Vestal	NY	Active
DSH330394BH	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON SQ-MEDICAL ONCOLOGY	30 Harrison Street	Johnson City	NY	Active
DSH330394BJ	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS 93 PENN AVE-SLEEP DISORDER CTR	93 Pennsylvania Avenue	Binghamton	NY	Active
DSH330394BK	Child	DSH	UHS	UHS Cardiology Johnson City	30 Harrison St.	Johnson City	NY	Terminated
DSH330394BL	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS Neuro Critical Care / Neurology	507 Main Street	Johnson City	NY	Terminated
DSH330394BM	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-GI LAB	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BN	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	Express Unit	33-57 Harrison Street	Johnson City	NY	Terminated
DSH330394BP	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	Infusion Center	33-57 Harrison Street	Johnson City	NY	Terminated
DSH330394BR	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-RADIOLOGY GENERAL INTERVENTIONAL	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BS	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-POST ANESTH CARE UNIT	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BT	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-DELIVERY ROOM	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BU	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-WOMENS HEALTH	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BV	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-SPECIAL DIAGNOSTIC UNIT	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BW	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-CARDIAC CATH LAB	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BX	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-AMBULATORY CARDIAC CARE	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BY	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-AMBULATORY SURGERY	33-57 Harrison Street	Johnson City	NY	Active
DSH330394BZ	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-EMERGENCY DEPARTMENT	33-57 Harrison Street	Johnson City	NY	Active
DSH330394C	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS SUMMIT-INTERNAL MEDICINE	SUMMIT BLDG., 33 MITCHELL AVENUE	BINGHAMTON	NY	Active
DSH330394CA	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-DIAGNOSTIC CARDIOLOGY	33-57 Harrison St	Johnson City	NY	Active
DSH330394CB	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-OB EMERGENCY DEPARTMENT	33-57 Harrison St	Johnson City	NY	Active
DSH330394CC	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG ST5	33-57 Harrison St	Johnson City	NY	Active
DSH330394CD	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG ST4 STEPDOWN	33-57 Harrison St	Johnson City	NY	Active
DSH330394CE	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG ST4	33-57 Harrison St	Johnson City	NY	Active
DSH330394CF	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG ST3	33-57 Harrison St	Johnson City	NY	Active
DSH330394CG	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG PEDS	33-57 Harrison St	Johnson City	NY	Active
DSH330394CH	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG NT4	33-57 Harrison St	Johnson City	NY	Active
DSH330394CJ	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG NT3	33-57 Harrison St	Johnson City	NY	Active
DSH330394CK	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-MED SURG NT2	33-57 Harrison St	Johnson City	NY	Active
DSH330394CL	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE ROBINSON ST-FAMILY PRACTICE	160 ROBINSON ST	BINGHAMTON	NY	Active
DSH330394CM	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS Robinson Street Walk In - Urgent Care	160 Robinson Street	Binghamton	NY	Terminated
DSH330394CN	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WMC-NUCLEAR MEDICINE	33-57 Harrison Street	Johnson City	NY	Active
DSH330394CP	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON SQ-NEURO ENDOVASCULAR	30 Harrison St	Johnson City	NY	Active
DSH330394CQ	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE 42 W MAIN ST OWEGO-CARDIOLOGY - CARDIOLOGY	42 W MAIN STREET	OWEGO	NY	Active
DSH330394D	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	BGH-PEDIATRICS	34 MITCHELL AVENUE	BINGHAMTON	NY	Active
DSH330394E	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE CLINTON ST-FAMILY PRACTICE	142 CLINTON STREET	BINGHAMTON	NY	Active
DSH330394F	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE CANDOR-FAMILY PRACTICE	54 MAIN STREET	CANDOR	NY	Active
DSH330394G	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE DEPOSIT-FAMILY PRACTICE	53 Pine Street	DEPOSIT	NY	Active
DSH330394H	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	JOHNSON CITY FAMILY CARE CENTER	507 Main Street	JOHNSON CITY	NY	Terminated
DSH330394J	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE WINDSOR-FAMILY PRACTICE	5 COLLEGE AVE	WINDSOR	NY	Active
DSH330394K	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS SUMMIT-MENTAL HEALTH	Summit Building	BINGHAMTON	NY	Active
DSH330394M	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS SUMMIT-METHADONE MAINTENANCE	33 MITCHELL AVENUE	BINGHAMTON	NY	Active
DSH330394P	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS SCHOOL CLINIC FRANKLIN-SCHOOL BASED HEALTH	262 CONKLIN AVE	BINGHAMTON	NY	Active
DSH330394Q	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS SCHOOL CLINIC ROOSEVELT-SCHOOL BASED HEALTH	9 OGDEN STREET	BINGHAMTON	NY	Active
DSH330394R	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS BGH-DENTAL CLINIC	10-42 MITCHELL AVE	BINGHAMTON	NY	Active
DSH330394S	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS 93 PENN AVE-DIABETES	93 Pennsylvania Avenue	Binghamton	NY	Active
DSH330394T	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	REGIONAL BLOOD DISORDERS CENTER	33-57 HARRISON STREET	JOHNSON CITY	NY	Terminated
DSH330394U	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS PRIM CARE NEWARK VALLEY-FAMILY PRACTICE	119 WHIG STREET	NEWARK VALLEY	NY	Active
DSH330394W	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS BGH-NEPHROLOGY	27 PARK AVENUE, 5TH FLOOR	BINGHAMTON	NY	Active
DSH330394X	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS BGH-PLASTIC SURGERY	27 PARK AVENUE, 2ND FLOOR	BINGHAMTON	NY	Active
DSH330394Y	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS 10 MITCHELL-CHEMICAL DEPENDENCY	10-42 MITCHELL AVENUE	BINGHAMTON	NY	Active
DSH330394Z	Child	DSH	UNITED HEALTH SERVICES HOSPITALS, INC.	UHS WILSON PLACE-OPERATING ROOM	52 Harrison Street	Johnson City	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 11:15:23 AM	9/4/2024 3:14:44 PM	9/4/2024 3:14 PM
Details	Entity Subname	Update	Recertification	UHS Vestal Breast Care Center	UHS VESTAL-BREAST CARE CENTER	9/4/2024 3:14 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 2:00:58 PM	9/6/2023 11:15:23 AM	9/6/2023 11:15 AM
Contacts	Primary Contact	Update	Group Change Request	Waldron, William G Director of Pharmacy United Health Services Hospitals, Inc 6077631835	Decaro, Ryan C. Pharmacy Business Manager United Health Services Hospitals, Inc 6077631838	1/26/2023 3:48 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 12:53:52 PM	9/7/2022 2:00:58 PM	9/7/2022 2:00 PM
Contacts	Authorizing Official	Update	AO Change Request	Schmidt, Robert Arthur Vice President, Clinical Services United Health Services Hospitals, Inc. 6077623359	Smith, James Mark Vice President - Chief Financial Officer United Health Services Hospitals, Inc. 6077623011	4/20/2022 8:11 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 10:01:38 AM	8/30/2021 12:53:52 PM	8/30/2021 12:53 PM
Contacts	Authorizing Official	Update	Profile Change Request	Schmidt, Robert Arthur Vice President, Clinical Services United Health Services Hospitals, Inc. 6077635720	Schmidt, Robert Arthur Vice President, Clinical Services United Health Services Hospitals, Inc. 6077623359	8/30/2021 12:02 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/9/2020 10:01 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 2:00:10 PM	9/9/2020 10:01:38 AM	9/9/2020 10:01 AM
Contacts	Authorizing Official	Update	Change Request	Boland, Elizabeth kay Sr. VP/CNO/COO United Health Services Hospitals 6776366694	Schmidt, Robert Arthur Vice President, Clinical Services United Health Services Hospitals, Inc. 6077635720	8/6/2020 9:43 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 9:11:04 AM	8/21/2019 2:00:10 PM	8/21/2019 2:00 PM
Contacts	Authorizing Official	Update	AO Change Request	MacDougall, Dave Senior Vice President and CFO United Health Services Hospitals 6077623006	Boland, Elizabeth kay Sr. VP/CNO/COO United Health Services Hospitals 6776366694	5/29/2019 7:08 AM
Contacts	Primary Contact	Update	Change Request	Waldron, William Associate Director of Pharmacy United Health Services Hospitals, Inc 6077631835	Waldron, William G Director of Pharmacy United Health Services Hospitals, Inc 6077631835	5/22/2019 6:29 AM
Details	Last Recertification Date	Update	Recertification	11/17/2017 8:48:42 AM	8/21/2018 9:11:04 AM	8/21/2018 9:11 AM
Details	Last Recertification Date	Update	Recertification	10/26/2017 12:44:28 PM	11/17/2017 8:48:42 AM	11/17/2017 8:48 AM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	10/26/2017 12:44:28 PM	10/26/2017 12:44 PM
Contacts	Authorizing Official	Update		MacDougall, Dave Senior Vice President and CFO 6077623006	MacDougall, Dave Senior Vice President and CFO United Health Services Hospitals 6077623006	9/27/2017 10:02 AM
Contacts	Primary Contact	Update		Waldron, William Associate Director of Pharmacy 6077631835	Waldron, William Associate Director of Pharmacy United Health Services Hospitals, Inc 6077631835	9/20/2017 8:51 AM
Contacts	Primary Contact	Insert			Waldron, William Associate Director of Pharmacy 6077631835	8/3/2017 10:40 AM
Contacts	Authorizing Official	Insert			MacDougall, Dave Senior Vice President and CFO 6077623006	8/3/2017 10:40 AM
Addresses	Main Address	Insert			4417 Vestal Parkway Vestal, NY 13850	8/3/2017 10:40 AM
Contacts	Signed By	Insert			GOMULKA, ROBERT G. SR. VP FISCAL SERVICES/CFO & TREASURER 6077623006	8/3/2017 10:40 AM
Details	Last Recertification Date	Update		8/18/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/22/2016 1:12 PM
Details	Last Recertification Date	Update		8/22/2014 12:00:00 AM	8/18/2015 12:00:00 AM	8/18/2015 10:58 AM
Details	Last Recertification Date	Update			8/22/2014 12:00:00 AM	8/22/2014 12:04 PM
Dates	Participating Approval Date	Update			12/9/2013 12:00:00 AM	12/9/2013 3:32 PM
Details	State	Update		Pending	Active	12/9/2013 3:32 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	12/9/2013 3:32 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH330394BG	12/6/2013 12:18 PM
Medicaid Billing	NPI: Number	Insert			1518998699	10/15/2013 3:29 PM
Details	Last Recertification Date	Insert				10/15/2013 3:29 PM
Details	Grant Number	Insert				10/15/2013 3:29 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/15/2013 3:29 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2013 3:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2013 3:29 PM
Details	Medicare Provider Number	Insert			330394	10/15/2013 3:29 PM
Details	Entity Name	Insert			UNITED HEALTH SERVICES HOSPITALS, INC.	10/15/2013 3:29 PM
Details	Program Code	Insert			DSH	10/15/2013 3:29 PM
Details	Entity Subname	Insert			UHS Vestal Breast Care Center	10/15/2013 3:29 PM
Dates	Participating Approval Date	Insert				10/15/2013 3:29 PM
Details	State	Insert			Pending	10/15/2013 3:29 PM
Dates	Registration Date	Insert			10/15/2013 12:00:00 AM	10/15/2013 3:29 PM
Dates	Signed By Date	Insert			10/15/2013 12:00:00 AM	10/15/2013 3:29 PM
Dates	Start Date	Insert				10/15/2013 3:29 PM
Terminations	Termination Comments	Insert				10/15/2013 3:29 PM
Terminations	Termination Date	Insert				10/15/2013 3:29 PM
Terminations	Termination Effective Date	Insert				10/15/2013 3:29 PM
Terminations	Termination Reason	Insert				10/15/2013 3:29 PM