Covered Entity Details

DSH310014H THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL (Active) - information as of 6/13/2025 12:04:53 AM

Main Details

Name

THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL

Subdivision Name

Cooper Women's Care Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310014H

Medicare Provider Number

310014

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2014

Participating Start Date

7/1/2014

Participating Approval Date

6/11/2014

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Cooper University Hospital
Brian M Reilly, CFO
(856) 342-2443

Primary Contact

Cooper University Hospital
Tricia Anne Ligato, Director Financial Operations
(856) 382-6519

Addresses

Street Address

Three Cooper Plaza
Suite 300
Camden, NJ 08103

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	4136004	1568442309
PA	000-8447240005
NY	279910
DE	1568442309

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
DSH310014A	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER SURGERY CENTER	900 CENTENNIAL BLVD	VOORHEES	NJ	Active
DSH310014B	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	RANCOCAS ENDOSCOPY CENTER	218C SUNSET ROAD	WILLINGBORO	NJ	Active
DSH310014C	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER DIGESTIVE HEALTH INSTITUTE	501 FELLOWSHIP ROAD	MT. LAUREL	NJ	Active
DSH310014D	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	MD Anderson Cancer Center COOPER CANCER INSTITUTE - HEMATOLOGY ONCOLOGY INFUSION SERVICES	900 CENTENNIAL BOULEVARD	VOORHEES	NJ	Active
DSH310014E	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER CANCER INSTITUTE GYNECOLOGIC ONCOLGY/INFUSION SERVICES	900 CENTENNIAL BOULEVARD	VOORHEES	NJ	Active
DSH310014F	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	MD Anderson Cancer Center COOPER CANCER INSTITUTE - HEMATOLOGY ONCOLOGY INFUSION SERVICES	1000 SALEM ROAD	WILLINGBORO	NJ	Active
DSH310014G	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	MD Anderson Cooper Cancer Center	Two Cooper Plaza	Camden	NJ	Active
DSH310014H	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	Cooper Women's Care Center	Three Cooper Plaza	Camden	NJ	Active
DSH310014J	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	Cooper Early Intervention Program	Three Cooper Plaza	Camden	NJ	Active
DSH310014K	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER UNIVERSITY HEALTH CARE MOORE - Moorestown Oncology	400 W ROUTE 38	MOORESTOWN	NJ	Active
DSH310014L	Child	DSH	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	COOPER UNIVERSITY HEALTH CARE MOORE - Moorestown Surgery Center	400 W ROUTE 38	MOORESTOWN	NJ	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	401705600 (MD)		1/15/2025 12:23 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	95655400 (FL)		1/15/2025 12:23 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 7:52:43 AM	8/12/2024 11:08:54 AM	8/12/2024 11:08 AM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	11/13/2023 12:00:00 AM		11/28/2023 9:36 AM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	11/28/2023 9:36 AM
Terminations	Termination Date	Update	OPA Cancel Termination Request	1/1/2024 12:00:00 AM		11/28/2023 9:36 AM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	11/13/2023 12:00:00 AM		11/28/2023 9:36 AM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Site closure		11/28/2023 9:36 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/13/2023 12:00:00 AM	11/28/2023 6:29 AM
Details	State	Update	Termination Request	Active	To Be Terminated	11/28/2023 6:29 AM
Terminations	Termination Date	Update	Termination Request		1/1/2024 12:00:00 AM	11/28/2023 6:29 AM
Terminations	Termination Effective Date	Update	Termination Request		11/13/2023 12:00:00 AM	11/28/2023 6:29 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	11/28/2023 6:29 AM
Details	Last Recertification Date	Update	Recertification	8/24/2022 8:37:00 AM	8/14/2023 7:52:43 AM	8/14/2023 7:52 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 2:49:56 PM	8/24/2022 8:37:00 AM	8/24/2022 8:37 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 2:03:41 PM	8/16/2021 2:49:56 PM	8/16/2021 2:49 PM
Contacts	Primary Contact	Update	Change Request	Bleacher, Ed Senior Vice President, Financial Operations & Managed Care Cooper University Hospital 8563564786	Ligato, Tricia Anne Director Financial Operations Cooper University Hospital 8563826519	5/26/2021 5:57 PM
Contacts	Authorizing Official	Update	Profile Change Request	Reilly, Brian M CFO Cooper University Health Care 8563422443	Reilly, Brian M CFO Cooper University Hospital 8563422443	5/12/2021 1:54 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1568442309 ( )		9/8/2020 2:03 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568442309	9/8/2020 2:03 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/8/2020 2:03 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 8:08:05 AM	9/8/2020 2:03:41 PM	9/8/2020 2:03 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 8:52:09 AM	8/20/2019 8:08:05 AM	8/20/2019 8:08 AM
Contacts	Authorizing Official	Update	Profile Change Request	Reilly, Brian M Interim CFO Cooper University Health Care 8563422443	Reilly, Brian M CFO Cooper University Health Care 8563422443	8/15/2018 8:55 AM
Details	Last Recertification Date	Update	Recertification	11/26/2017 10:19:50 AM	8/15/2018 8:52:09 AM	8/15/2018 8:52 AM
Details	Entity Name	Update	Recertification	The Cooper Health System DBA Cooper University Hospital	THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL	11/29/2017 7:46 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/26/2017 10:19:50 AM	11/26/2017 10:19 AM
Contacts	Authorizing Official	Insert	AO Change Request		Reilly, Brian M Interim CFO Cooper University Health Care 8563422443	11/22/2017 11:06 AM
Contacts	Primary Contact	Update		Bleacher, Ed Senior Vice President, Financial Operations & Managed Care 8563564786	Bleacher, Ed Senior Vice President, Financial Operations & Managed Care Cooper University Hospital 8563564786	11/15/2017 11:50 AM
Contacts	Signed By	Insert			Shirley, Douglas E. Senior Executive VP and CFO 8563422443	7/27/2017 8:09 AM
Contacts	Primary Contact	Update		Curatola, Robert J. Senior Director of Financial Planning 8563826522	Bleacher, Ed Senior Vice President, Financial Operations & Managed Care 8563564786	6/13/2017 8:18 PM
Addresses	Main Address	Insert			Three Cooper Plaza Suite 300 Camden, NJ 08103	6/13/2017 8:17 PM
Contacts	Primary Contact	Insert			Curatola, Robert J. Senior Director of Financial Planning 8563826522	8/16/2016 9:26 AM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 9:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Number	Insert			000-8447240005	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: State	Insert			PA	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Number	Insert			279910	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: State	Insert			NY	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Number	Insert			1568442309	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: State	Insert			DE	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Number	Insert			401705600	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: State	Insert			MD	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: Number	Insert			95655400	6/8/2016 3:04 PM
Medicaid Billing	Medicaid: State	Insert			FL	6/8/2016 3:04 PM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/12/2015 3:35 PM
Details	Last Recertification Date	Update			8/7/2014 12:00:00 AM	8/7/2014 2:07 PM
Dates	Participating Approval Date	Update			6/11/2014 12:00:00 AM	6/11/2014 4:37 PM
Details	State	Update		Pending	Active	6/11/2014 4:37 PM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	6/11/2014 4:37 PM
Details	340B ID	Update		ONLINE_REG	DSH310014H	5/22/2014 11:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/15/2014 4:47 PM
Medicaid Billing	Medicaid: Number	Insert			4136004	4/15/2014 4:47 PM
Medicaid Billing	Medicaid: State	Insert			NJ	4/15/2014 4:47 PM
Medicaid Billing	NPI: Number	Insert			1568442309	4/15/2014 4:47 PM
Details	Last Recertification Date	Insert				4/15/2014 4:47 PM
Details	Grant Number	Insert				4/15/2014 4:47 PM
Details	340B ID	Insert			ONLINE_REG	4/15/2014 4:47 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2014 4:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2014 4:47 PM
Details	Medicare Provider Number	Insert			310014	4/15/2014 4:47 PM
Details	Entity Name	Insert			The Cooper Health System DBA Cooper University Hospital	4/15/2014 4:47 PM
Details	Program Code	Insert			DSH	4/15/2014 4:47 PM
Details	Entity Subname	Insert			Cooper Women's Care Center	4/15/2014 4:47 PM
Dates	Participating Approval Date	Insert				4/15/2014 4:47 PM
Details	State	Insert			Pending	4/15/2014 4:47 PM
Dates	Registration Date	Insert			4/15/2014 12:00:00 AM	4/15/2014 4:47 PM
Dates	Signed By Date	Insert			4/15/2014 12:00:00 AM	4/15/2014 4:47 PM
Dates	Start Date	Insert				4/15/2014 4:47 PM
Terminations	Termination Comments	Insert				4/15/2014 4:47 PM
Terminations	Termination Date	Insert				4/15/2014 4:47 PM
Terminations	Termination Effective Date	Insert				4/15/2014 4:47 PM
Terminations	Termination Reason	Insert				4/15/2014 4:47 PM