340B Drug Pricing Program Database


DSH330044F MVHS, Inc. DBA: Wynn Hospital (Terminated) - information as of 5/3/2025 11:30:45 PM

Main Details
MVHS, Inc. DBA: Wynn Hospital
Dental Health Center
Disproportionate Share Hospital
No
DSH330044F
330044


Additional Details
Terminated
4/15/2014
7/1/2014
4/25/2014
9/1/2023

7/1/2024
Business decision by the Covered Entity

Contacts

MVHS Inc, DBA Wynn Hospital
Louis Aiello, Sr. VP Finance/ CFO
(315) 917-8213

MVHS, Inc. DBA: Wynn Hospital
James Humphrey, AVP Finance/ Controller
(315) 801-4326

Addresses

1714 Burrstone Road
New Hartford, NY 13413

MVHS, INC.
1676 Sunset Ave.
Utica, NY 13502


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NY00384309,0031930241205877172,1649350380
Shipping Addresses

MVHS, INC.
1676 Sunset Ave.
Utica, NY 13502
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH330044AChildDSHMVHS, Inc. DBA: Wynn HospitalImaging Center106 Business Park DriveUticaNYActive
DSH330044AAChildDSHFaxton St. Luke's HealthcareBalance Center1676 Sunset Ave.UticaNYTerminated
DSH330044ABChildDSHFaxton St. Luke's HealthcareLymphedema Program1676 Sunset Ave.UticaNYTerminated
DSH330044ACChildDSHFaxton St. Luke's HealthcarePhysical Therapy1676 Sunset Ave.UticaNYTerminated
DSH330044ADChildDSHFaxton St. Luke's HealthcareOccupational Therapy1676 Sunset Ave.UticaNYTerminated
DSH330044AEChildDSHFaxton St. Luke's HealthcareSpeech Therapy Faxton1676 Sunset Ave.UticaNYTerminated
DSH330044AFChildDSHFaxton St. Luke's HealthcareHome Hemodialysis1676 Sunset Ave.UticaNYTerminated
DSH330044AGChildDSHFaxton St. Luke's HealthcareHome Peritoneal Dialysis1676 Sunset Ave.UticaNYTerminated
DSH330044AHChildDSHFaxton St. Luke's HealthcareRenal Dialysis1676 Sunset Ave.UticaNYTerminated
DSH330044AJChildDSHFaxton St. Luke's HealthcareAmbulatory Surgery Faxton1676 Sunset Ave.UticaNYTerminated
DSH330044AKChildDSHMVHS, Inc. DBA: Wynn HospitalAudiology1676 Sunset Ave.UticaNYActive
DSH330044ALChildDSHMVHS, Inc. DBA: Wynn HospitalUltrasound Faxton1676 Sunset Ave.UticaNYActive
DSH330044AMChildDSHMVHS, Inc. DBA: Wynn HospitalOutpatient Infusion1676 Sunset Ave.UticaNYActive
DSH330044ANChildDSHFaxton St. Luke's HealthcareEndo/ GI Unit Faxton1676 Sunset Ave.UticaNYTerminated
DSH330044APChildDSHMVHS, Inc. DBA: Wynn HospitalDiabetes Education1676 Sunset Ave.UticaNYActive
DSH330044AQChildDSHMVHS, Inc. DBA: Wynn HospitalPet Scan1676 Sunset Ave.UticaNYActive
DSH330044ARChildDSHFaxton St. Luke's HealthcareUrgent Care1676 Sunset Ave.UticaNYTerminated
DSH330044ASChildDSHMVHS, Inc. DBA: Wynn HospitalACP Surgeons1658 Champlin AveUticaNYActive
DSH330044ATChildDSHFaxton St. Luke's HealthcareVascular Surgery1676 Sunset AvenueUticaNYTerminated
DSH330044AUChildDSHMVHS, Inc. DBA: Wynn HospitalOrthopedic Surgery1903 Sunset AvenueUticaNYActive
DSH330044AVChildDSHMVHS, Inc. DBA: Wynn HospitalGI Office1658 Champlin Ave.UticaNYActive
DSH330044AWChildDSHFaxton St. Luke's HealthcareSAUQUOIT MEDICAL OFFICE2888 ONEIDA STSAUQUOITNYTerminated
DSH330044AXChildDSHMVHS, Inc. DBA: Wynn HospitalNeuro Interventional1656 Champlin Ave.UticaNYTerminated
DSH330044AYChildDSHMVHS, Inc. DBA: Wynn HospitalMVHS Pulmonary Group35 Riverside DriveUticaNYActive
DSH330044AZChildDSHFaxton St. Luke's HealthcareWATERVILLE MEDICAL OFFICE117 W MAIN STWATERVILLENYTerminated
DSH330044BChildDSHFaxton St. Luke's HealthcareRenal Dialysis - Rome91 Perimeter Road Mohawk Glenn, Suite 140RomeNYTerminated
DSH330044BAChildDSHMVHS, Inc. DBA: Wynn HospitalCLINTON MEDICAL CENTER101 COLLEGE STCLINTONNYActive
DSH330044BBChildDSHMVHS, Inc. DBA: Wynn HospitalNeuro Science Physician Office1658 Champlin Ave.UticaNYActive
DSH330044BCChildDSHMVHS, Inc. DBA: Wynn HospitalMVHS Surgeons - Faxton Location - Surgery1676 Sunset Ave.UticaNYActive
DSH330044BDChildDSHMVHS, Inc. DBA: Wynn HospitalOneida Medical Office - Primary Care131 Main StreetOneidaNYActive
DSH330044BEChildDSHMVHS, Inc. DBA: Wynn HospitalRome Medical Office - Primary Care1617 North James StreetRomeNYActive
DSH330044BFChildDSHMVHS, Inc. DBA: Wynn HospitalUpstate Urology at MVHS - Urology1676 Sunset AvenueUticaNYActive
DSH330044BGChildDSHMVHS, Inc. DBA: Wynn HospitalHerkimer Oncology - Oncology201 East State StreetHerkimerNYActive
DSH330044BHChildDSHMVHS, Inc. DBA: Wynn HospitalOncology Clinic - Oncology807 Newell StreetUticaNYActive
DSH330044BJChildDSHMVHS, Inc. DBA: Wynn HospitalRome Oncology Office - Oncology91 Perimeter RoadRomeNYActive
DSH330044BKChildDSHMVHS, Inc. DBA: Wynn HospitalSurburban OB - OB/GYN1656 Champlin Ave.UticaNYActive
DSH330044BLChildDSHMVHS, Inc. DBA: Wynn HospitalOP Psychiatry - Psychiatry1676 Sunset Ave.New HartfordNYActive
DSH330044BMChildDSHMVHS, Inc. DBA: Wynn HospitalPulmonary Function Testing - Respiratory Therapy4401 Middle Settlement RoadNew HartfordNYActive
DSH330044BNChildDSHMVHS, Inc. DBA: Wynn HospitalMVHS Podiatry - Podiatry120 Hobart StreetUticaNYActive
DSH330044BPChildDSHMVHS, Inc. DBA: Wynn HospitalSleep Laboratroy - Sleep Studies2215 Genesee StreetUticaNYActive
DSH330044BQChildDSHMVHS, Inc. DBA: Wynn HospitalWound Care - Wound CareMedical Arts BuildingNew HartfordNYActive
DSH330044BRChildDSHMVHS, Inc. DBA: Wynn HospitalSr. Rose Vincent Family Med Ctr - Primary Care120 Hobart StreetUticaNYActive
DSH330044BSChildDSHMVHS, Inc. DBA: Wynn HospitalMG - Prim - Town of Webb - Primary Care114 South Shore RoadOld ForgeNYActive
DSH330044BTChildDSHMVHS, Inc. DBA: Wynn HospitalMG - Little Falls Primary Care - Primary Care500 East Main StreetLittle FallsNYActive
DSH330044BUChildDSHMVHS, Inc. DBA: Wynn HospitalMG - Prim - East Utica - Primary Care1256 Culver Ave.UticaNYActive
DSH330044BVChildDSHMVHS, Inc. DBA: Wynn HospitalMG - Prim - Children's Health - Pediatric2212 Genesee StreetUticaNYActive
DSH330044BWChildDSHMVHS, Inc. DBA: Wynn HospitalMG - Spec - Bariatric Surgery - Bariatric Surgery1676 Sunset Ave.UticaNYActive
DSH330044BXChildDSHMVHS, Inc. DBA: Wynn HospitalComm Med - Infectious Disease - Infectious Disease6 Hampden PlaceUticaNYActive
DSH330044BYChildDSHMVHS, Inc. DBA: Wynn HospitalEndo / GI Unit MVEC - Endoscopy116 Business Park DriveUticaNYActive
DSH330044BZChildDSHMVHS, Inc. DBA: Wynn HospitalMedical Group Trauma Surgeons - Trauma Surgeons601 State StreetUticaNYActive
DSH330044CChildDSHFaxton St. Luke's HealthcareRenal Dialysis - Oneida131 Main Street, Suite 201OneidaNYTerminated
DSH330044CAChildDSHMVHS, Inc. DBA: Wynn HospitalVascular Surgery - Vascular Surgery601 State StreetUticaNYActive
DSH330044CBChildDSHMVHS, Inc. DBA: Wynn HospitalMG - Spec - CT Surgery - Cardio Thoracic SurgeonsMG - Spec - CT SurgeryUticaNYActive
DSH330044CCChildDSHMVHS, Inc. DBA: Wynn HospitalMedical Group - Cardiology - CardiologyMedical Arts BuildingNew HartfordNYTerminated
DSH330044DChildDSHFaxton St. Luke's HealthcareRenal Dialysis - MasonicSoldiers & Sailors Building, 1st FloorUticaNYTerminated
DSH330044EChildDSHFaxton St. Luke's HealthcareRenal Dialysis - Hamilton10 Eaton StreetHamiltonNYTerminated
DSH330044FChildDSHMVHS, Inc. DBA: Wynn HospitalDental Health Center1714 Burrstone RoadNew HartfordNYTerminated
DSH330044GChildDSHFaxton St. Luke's HealthcareGenesee Urgent Care1904 Genesee StreetUticaNYTerminated
DSH330044HChildDSHMVHS, Inc. DBA: Wynn HospitalWhitesboro Medical Office37 Main StreetWhitesboroNYActive
DSH330044JChildDSHMVHS, Inc. DBA: Wynn HospitalWaterville Medical Office358 Madison StreetWatervilleNYActive
DSH330044KChildDSHMVHS, Inc. DBA: Wynn HospitalWashington Mills Medical Office3946 Oneida StreetNew HartfordNYActive
DSH330044LChildDSHMVHS, Inc. DBA: Wynn HospitalNorth Utica Medical Office417 Trenton RoadUticaNYActive
DSH330044MChildDSHMVHS, Inc. DBA: Wynn HospitalNew Hartford Medical Office8411 Seneca TurnpikeNew HartfordNYActive
DSH330044NChildDSHMVHS, Inc. DBA: Wynn HospitalMohawk Valley Medical Office201 East State StreetHerkimerNYActive
DSH330044PChildDSHMVHS, Inc. DBA: Wynn HospitalBoonville Medical Office13460 State Route 12BoonvilleNYActive
DSH330044QChildDSHMVHS, Inc. DBA: Wynn HospitalBarneveld Medical Office7980 State Route 12BarneveldNYActive
DSH330044RChildDSHFaxton St. Luke's HealthcareRenal Dialysis - SLH1650 Champlin Ave.UticaNYTerminated
DSH330044SChildDSHFaxton St. Luke's HealthcareRenal Dialysis - Herkimer201 East State StreetHerkimerNYTerminated
DSH330044TChildDSHFaxton St. Luke's HealthcareOperating Room Faxton1676 Sunset Ave.UticaNYTerminated
DSH330044UChildDSHFaxton St. Luke's HealthcareRecovery Room Faxton1676 Sunset Ave.UticaNYTerminated
DSH330044VChildDSHMVHS, Inc. DBA: Wynn HospitalRadiology Diagnostic Faxton1676 Sunset AveUticaNYActive
DSH330044WChildDSHMVHS, Inc. DBA: Wynn HospitalCancer Care Program1676 Sunset AvenueUticaNYActive
DSH330044XChildDSHMVHS, Inc. DBA: Wynn HospitalRadiation Medicine1676 Sunset Ave.UticaNYActive
DSH330044YChildDSHFaxton St. Luke's HealthcareNuclear Medicine Faxton1676 Sunset Ave.UticaNYTerminated
DSH330044ZChildDSHMVHS, Inc. DBA: Wynn HospitalCat Scan Faxton1676 Sunset Ave.UticaNYActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated7/1/2024 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 4/30/2024 12:00:00 AM6/20/2024 7:45 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated6/20/2024 7:45 AM
TerminationsTermination DateUpdateTermination Request 7/1/2024 12:00:00 AM6/20/2024 7:45 AM
TerminationsTermination Effective DateUpdateTermination Request 5/1/2024 12:00:00 AM6/20/2024 7:45 AM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity6/20/2024 7:45 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestAiello, Louis Sr. VP Finance/ CFO Faxton St. Luke's Healthcare 3156246143Aiello, Louis Sr. VP Finance/ CFO MVHS Inc, DBA Wynn Hospital 31591782135/31/2024 8:55 AM
ContactsPrimary ContactUpdateProfile Change RequestHumphrey, James AVP Finance/ Controller Faxton St. Luke's Healthcare 3158014326Humphrey, James AVP Finance/ Controller MVHS, Inc. DBA: Wynn Hospital 31580143265/28/2024 7:29 AM
AddressesShipping AddressUpdateChange RequestFaxton St. Luke's Healthcare 1676 Sunset Ave. Utica, NY 13502MVHS, INC. 1676 Sunset Ave. Utica, NY 135022/2/2024 10:54 AM
AddressesBilling AddressUpdateChange RequestFaxton St. Luke's Healthcare 1676 Sunset Ave. Utica, NY 13502MVHS, INC. 1676 Sunset Ave. Utica, NY 135022/2/2024 10:54 AM
DetailsEntity NameUpdateChange RequestFaxton St. Luke's HealthcareMVHS, Inc. DBA: Wynn Hospital12/19/2023 8:14 AM
DetailsLast Recertification DateUpdateRecertification8/25/2022 11:34:58 AM9/1/2023 8:48:08 AM9/1/2023 8:48 AM
DetailsLast Recertification DateUpdateRecertification9/8/2021 4:55:43 PM8/25/2022 11:34:58 AM8/25/2022 11:34 AM
DetailsLast Recertification DateUpdateRecertification9/8/2020 10:15:19 AM9/8/2021 4:55:43 PM9/8/2021 4:55 PM
Medicaid BillingNPI: NumberDeleteRecertification1649350380 ( ) 9/8/2020 10:15 AM
Medicaid BillingNPI: NumberInsertRecertification 12058771729/8/2020 10:15 AM
Medicaid BillingNPI: StateInsertRecertification NY9/8/2020 10:15 AM
Medicaid BillingNPI: NumberInsertRecertification 16493503809/8/2020 10:15 AM
Medicaid BillingNPI: StateInsertRecertification NY9/8/2020 10:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1205877172 ( ) 9/8/2020 10:15 AM
DetailsLast Recertification DateUpdateRecertification8/26/2019 8:50:51 AM9/8/2020 10:15:19 AM9/8/2020 10:15 AM
DetailsLast Recertification DateUpdateRecertification8/27/2018 8:46:12 AM8/26/2019 8:50:51 AM8/26/2019 8:50 AM
DatesLast Date That 340B Drugs PurchasedUpdateOPA Cancel Termination Request3/12/2019 12:00:00 AM 5/21/2019 10:56 AM
DetailsStateUpdateOPA Cancel Termination RequestTo Be TerminatedActive5/21/2019 10:56 AM
TerminationsTermination DateUpdateOPA Cancel Termination Request7/1/2019 12:00:00 AM 5/21/2019 10:56 AM
TerminationsTermination Effective DateUpdateOPA Cancel Termination Request3/12/2019 12:00:00 AM 5/21/2019 10:56 AM
TerminationsTermination ReasonUpdateOPA Cancel Termination RequestBusiness decision by the Covered Entity 5/21/2019 10:56 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 3/12/2019 12:00:00 AM5/19/2019 11:03 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated5/19/2019 11:03 AM
TerminationsTermination DateUpdateTermination Request 7/1/2019 12:00:00 AM5/19/2019 11:03 AM
TerminationsTermination Effective DateUpdateTermination Request 3/12/2019 12:00:00 AM5/19/2019 11:03 AM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity5/19/2019 11:03 AM
DetailsLast Recertification DateUpdateRecertification11/27/2017 12:58:39 PM8/27/2018 8:46:12 AM8/27/2018 8:46 AM
AddressesShipping AddressInsertChange Request Faxton St. Luke's Healthcare 1676 Sunset Ave. Utica, NY 135025/1/2018 3:57 PM
AddressesBilling AddressUpdateChange RequestFSLH - Dental Health Center PO Box 479 Utica, NY 13503Faxton St. Luke's Healthcare 1676 Sunset Ave. Utica, NY 135025/1/2018 3:57 PM
DetailsLast Recertification DateUpdateRecertification8/23/2016 12:00:00 AM11/27/2017 12:58:39 PM11/27/2017 12:58 PM
ContactsPrimary ContactUpdate Humphrey, James AVP Finance/ Controller 3158014326Humphrey, James AVP Finance/ Controller Faxton St. Luke's Healthcare 315801432610/18/2017 2:48 PM
ContactsAuthorizing OfficialUpdate Aiello, Louis Sr. VP Finance/ CFO 3156246143Aiello, Louis Sr. VP Finance/ CFO Faxton St. Luke's Healthcare 315624614310/18/2017 10:19 AM
ContactsPrimary ContactInsert  Humphrey, James AVP Finance/ Controller 31580143268/2/2017 1:51 PM
ContactsAuthorizing OfficialInsert  Aiello, Louis Sr. VP Finance/ CFO 31562461438/2/2017 1:51 PM
ContactsSigned ByInsert  Aiello, Louis Sr. VP Finance/ CFO 31562461437/14/2017 9:04 AM
AddressesMain AddressInsert   1714 Burrstone Road New Hartford, NY 134134/26/2017 12:53 PM
AddressesBilling AddressInsert  FSLH - Dental Health Center PO Box 479 Utica, NY 135034/26/2017 12:53 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/9/2017 9:25 AM
Medicaid BillingMedicaid: NumberInsert  0031930243/9/2017 9:25 AM
Medicaid BillingMedicaid: StateInsert  NY3/9/2017 9:25 AM
Medicaid BillingNPI: NumberInsert  12058771723/9/2017 9:25 AM
DetailsLast Recertification DateUpdate 8/21/2015 12:00:00 AM8/23/2016 12:00:00 AM8/23/2016 10:40 AM
DetailsLast Recertification DateUpdate 8/25/2014 12:00:00 AM8/21/2015 12:00:00 AM8/21/2015 1:38 PM
DetailsLast Recertification DateUpdate  8/25/2014 12:00:00 AM8/25/2014 7:24 AM
DatesParticipating Approval DateUpdate  4/25/2014 12:00:00 AM4/25/2014 12:44 PM
DetailsStateUpdate PendingActive4/25/2014 12:44 PM
DatesStart DateUpdate  7/1/2014 12:00:00 AM4/25/2014 12:44 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REGDSH330044F4/24/2014 3:45 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2014 5:38 AM
Medicaid BillingMedicaid: NumberInsert  003843094/15/2014 5:38 AM
Medicaid BillingMedicaid: StateInsert  NY4/15/2014 5:38 AM
Medicaid BillingNPI: NumberInsert  16493503804/15/2014 5:38 AM
DetailsLast Recertification DateInsert   4/15/2014 5:38 AM
DetailsGrant NumberInsert   4/15/2014 5:38 AM
Details340B IDInsert  OUTPATIENT_ONLINE_REG4/15/2014 5:38 AM
DetailsIs Authorizing Official EHB DataInsert   4/15/2014 5:38 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/15/2014 5:38 AM
DetailsMedicare Provider NumberInsert  3300444/15/2014 5:38 AM
DetailsEntity NameInsert  Faxton St. Luke's Healthcare4/15/2014 5:38 AM
DetailsProgram CodeInsert  DSH4/15/2014 5:38 AM
DetailsEntity SubnameInsert  Dental Health Center4/15/2014 5:38 AM
DatesParticipating Approval DateInsert   4/15/2014 5:38 AM
DetailsStateInsert  Pending4/15/2014 5:38 AM
DatesRegistration DateInsert  4/15/2014 12:00:00 AM4/15/2014 5:38 AM
DatesSigned By DateInsert  4/15/2014 12:00:00 AM4/15/2014 5:38 AM
DatesStart DateInsert   4/15/2014 5:38 AM
TerminationsTermination CommentsInsert   4/15/2014 5:38 AM
TerminationsTermination DateInsert   4/15/2014 5:38 AM
TerminationsTermination Effective DateInsert   4/15/2014 5:38 AM
TerminationsTermination ReasonInsert   4/15/2014 5:38 AM