Covered Entity Details

DSH330276C NATHAN LITTAUER HOSPITAL (Active) - information as of 6/28/2025 12:19:42 AM

Main Details

Name

NATHAN LITTAUER HOSPITAL

Subdivision Name

Mayfield Primary Care Center - Internal Medicine

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330276C

Medicare Provider Number

330276

Outpatient Facility Provider Number

330276

Additional Details

Current Program Status

Active

Registration Date

7/11/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/12/2014

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Nathan Littauer Hospital
Michael Ostrander, Vice President-Finance & CFO
(518) 773-5480

Primary Contact

Nathan Littauer Hospital
Brenda Hammons, Pharmacy 340B Coordinator
(518) 773-5582

Addresses

Street Address

2497 State Highway 30
Mayfield, NY 12117

Billing Address

Nathan Littauer Hospital
99 East State Street
Gloversville, NY 12078

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?
No

Shipping Addresses

Shipping Address 1

Nathan Littauer Hospital
99 East State Street
Gloversville, NY 12078

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
DSH330276A	Child	DSH	NATHAN LITTAUER HOSPITAL	Johnstown Primary/Specialty Care Center	110 Decker Drive Suite 100	Johnstown	NY	Active
DSH330276AA	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Urology	99 East State Street	Gloversville	NY	Active
DSH330276AB	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Neurology	99 East State Street	Gloversville	NY	Active
DSH330276AC	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Surgery	99 East State Street	Gloversville	NY	Active
DSH330276AD	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Women's Health	99 East State Street	Gloversville	NY	Active
DSH330276AE	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Anesthesia	99 East State Street	Gloversville	NY	Terminated
DSH330276AF	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Internal Medicine	99 East State Street	Gloversville	NY	Active
DSH330276AG	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Family Practice	99 East State Street	Gloversville	NY	Active
DSH330276AH	Child	DSH	NATHAN LITTAUER HOSPITAL	Broadalbin Primary/Specialty Care	103 COUNTY HIGHWAY 138	BROADALBIN	NY	Active
DSH330276AJ	Child	DSH	NATHAN LITTAUER HOSPITAL	Steele Avenue Primary Care Center - Otolaryngology	182 Steele Avenue	Gloversville	NY	Active
DSH330276AK	Child	DSH	NATHAN LITTAUER HOSPITAL	Amsterdam Primary/Urgent Care Center - Primary Care	375 Golf Course Road	Amsterdam	NY	Active
DSH330276AL	Child	DSH	NATHAN LITTAUER HOSPITAL	Amsterdam Primary/Urgent Care Center - Urgent Care	375 Golf Course Road	Amsterdam	NY	Active
DSH330276B	Child	DSH	NATHAN LITTAUER HOSPITAL	Mayfield Primary Care Center - Family Practice	2497 State Highway 30	Mayfield	NY	Active
DSH330276C	Child	DSH	NATHAN LITTAUER HOSPITAL	Mayfield Primary Care Center - Internal Medicine	2497 State Highway 30	Mayfield	NY	Active
DSH330276D	Child	DSH	NATHAN LITTAUER HOSPITAL	Mayfield Primary Care Center - Pediatrics	2497 State Highway 30	Mayfield	NY	Terminated
DSH330276E	Child	DSH	NATHAN LITTAUER HOSPITAL	Primary Care Center at Speculator - Internal Medicine	2862 State Highway 8	Speculator	NY	Active
DSH330276F	Child	DSH	NATHAN LITTAUER HOSPITAL	Caroga Lake Primary Care Center - Family Practice	1840 State Highway 10	Caroga Lake	NY	Active
DSH330276G	Child	DSH	NATHAN LITTAUER HOSPITAL	Steele Avenue Primary Care Center - Pediatrics	182 Steele Avenue	Gloversville	NY	Terminated
DSH330276H	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Internal Medicine	4104 State Highway 30	Perth	NY	Active
DSH330276J	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Family Practice	4104 State Highway 30	Perth	NY	Active
DSH330276K	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Pediatrics	4104 State Highway 30	Perth	NY	Active
DSH330276L	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Women's Health	4104 State Highway 30	Perth	NY	Active
DSH330276M	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Neurology	4104 State Highway 30	Perth	NY	Terminated
DSH330276N	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Podiatry	4104 State Highway 30	Perth	NY	Active
DSH330276P	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Radiology	4104 State Highway 30	Perth	NY	Terminated
DSH330276Q	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Occupational Medicine	4104 State Highway 30	Perth	NY	Active
DSH330276R	Child	DSH	NATHAN LITTAUER HOSPITAL	Primary/Specialty Care Center at Decker Drive - Pediatrics	110 Decker Drive	Johnstown	NY	Terminated
DSH330276S	Child	DSH	NATHAN LITTAUER HOSPITAL	FonClair Terrace Primary Care Center - Primary Care	2 FonClair Terrace	Johnstown	NY	Terminated
DSH330276T	Child	DSH	NATHAN LITTAUER HOSPITAL	Johnstown Surgery Center - Ambulatory Surgery	434 South Kingsboro Avenue Extension	Johnstown	NY	Active
DSH330276U	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center / Gastroenterology	4104 State Highway 30	Perth	NY	Terminated
DSH330276V	Child	DSH	NATHAN LITTAUER HOSPITAL	Kingsboro GI Center/Gastroenterology	434 South Kingsboro Avenue Extension	Johnstown	NY	Active
DSH330276W	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center / Gastroenterology	99 East State Street	Gloversville	NY	Terminated
DSH330276X	Child	DSH	NATHAN LITTAUER HOSPITAL	Fonda Primary/Specialty Care Center - Family Practice	46 East Main Street	Fonda	NY	Active
DSH330276Y	Child	DSH	NATHAN LITTAUER HOSPITAL	Fonda Primary/Specialty Care Center - Internal Medicine	46 East Main Street	Fonda	NY	Active
DSH330276Z	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Pulmonology	99 East State Street	Gloversville	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 12:03:18 PM	8/19/2024 9:57:50 AM	8/19/2024 9:57 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 8:28:52 AM	8/17/2023 12:03:18 PM	8/17/2023 12:03 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 8:26:50 AM	8/29/2022 8:28:52 AM	8/29/2022 8:28 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 10:51:14 AM	8/24/2021 8:26:50 AM	8/24/2021 8:26 AM
Addresses	Main Address	Update	Change Request	Route 30 Mayfield, NY 12117	2497 State Highway 30 Mayfield, NY 12117	12/8/2020 11:06 AM
Details	Last Recertification Date	Update	Recertification	9/6/2019 9:29:13 AM	9/3/2020 10:51:14 AM	9/3/2020 10:51 AM
Details	Last Recertification Date	Update	Recertification	8/31/2018 11:41:39 AM	9/6/2019 9:29:13 AM	9/6/2019 9:29 AM
Contacts	Primary Contact	Update	Profile Change Request	Hammons, Brenda Assistant to the CFO & CIO Nathan Littauer Hospital 5187735485	Hammons, Brenda Pharmacy 340B Coordinator Nathan Littauer Hospital 5187735582	1/9/2019 10:24 AM
Details	Last Recertification Date	Update	Recertification	11/22/2017 2:13:08 PM	8/31/2018 11:41:39 AM	8/31/2018 11:41 AM
Addresses	Billing Address	Insert	Change Request		Nathan Littauer Hospital 99 East State Street Gloversville, NY 12078	7/17/2018 7:05 AM
Addresses	Shipping Address	Insert	Change Request		Nathan Littauer Hospital 99 East State Street Gloversville, NY 12078	7/17/2018 7:05 AM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	11/22/2017 2:13:08 PM	11/22/2017 2:13 PM
Contacts	Authorizing Official	Update		Ostrander, Michael Vice President-Finance & CFO 5187735480	Ostrander, Michael Vice President-Finance & CFO Nathan Littauer Hospital 5187735480	10/20/2017 2:08 PM
Contacts	Signed By	Update		Ostrander, Michael Vice President-Finance & CFO 5187735480	Ostrander, Michael Vice President-Finance & CFO Nathan Littauer Hospital 5187735480	10/20/2017 2:08 PM
Contacts	Primary Contact	Update		Hammons, Brenda Assistant to the CFO & CIO 5187735485	Hammons, Brenda Assistant to the CFO & CIO Nathan Littauer Hospital 5187735485	10/10/2017 2:28 PM
Contacts	Authorizing Official	Insert			Ostrander, Michael Vice President-Finance & CFO 5187735480	5/11/2017 7:17 AM
Contacts	Signed By	Insert			Ostrander, Michael Vice President-Finance & CFO 5187735480	5/11/2017 7:17 AM
Contacts	Primary Contact	Insert			Hammons, Brenda Assistant to the CFO & CIO 5187735485	5/11/2017 7:17 AM
Addresses	Main Address	Insert			Route 30 Mayfield, NY 12117	8/26/2016 2:27 PM
Details	Last Recertification Date	Update		9/1/2015 12:00:00 AM	8/26/2016 12:00:00 AM	8/26/2016 2:27 PM
Details	Last Recertification Date	Update			9/1/2015 12:00:00 AM	9/1/2015 11:07 AM
Details	Entity Subname	Update		Mayfield Primary Care Center - Internal Medicine / Internal Medicine	Mayfield Primary Care Center - Internal Medicine	12/31/2014 3:51 PM
Details	Entity Subname	Update		Mayfield Primary Care Center - Internal Medicine	Mayfield Primary Care Center - Internal Medicine / Internal Medicine	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			9/12/2014 12:00:00 AM	9/12/2014 5:48 PM
Details	State	Update		Pending	Active	9/12/2014 5:48 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/12/2014 5:48 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45276	DSH330276C	9/11/2014 7:09 AM
Details	Entity Subname	Update		Mayfield Primary Care Center	Mayfield Primary Care Center - Internal Medicine	9/11/2014 7:09 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45276	7/11/2014 11:35 AM
Details	Last Recertification Date	Insert				7/11/2014 11:35 AM
Details	Grant Number	Insert				7/11/2014 11:35 AM
Details	340B ID	Insert				7/11/2014 11:35 AM
Details	Is Authorizing Official EHB Data	Insert				7/11/2014 11:35 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/11/2014 11:35 AM
Details	Medicare Provider Number	Insert			330276	7/11/2014 11:35 AM
Details	Entity Name	Insert			NATHAN LITTAUER HOSPITAL	7/11/2014 11:35 AM
Details	Program Code	Insert			DSH	7/11/2014 11:35 AM
Details	Entity Subname	Insert			Mayfield Primary Care Center	7/11/2014 11:35 AM
Dates	Participating Approval Date	Insert				7/11/2014 11:35 AM
Details	State	Insert			Pending	7/11/2014 11:35 AM
Dates	Registration Date	Insert			7/11/2014 12:00:00 AM	7/11/2014 11:35 AM
Dates	Signed By Date	Insert			7/11/2014 12:00:00 AM	7/11/2014 11:35 AM
Dates	Start Date	Insert				7/11/2014 11:35 AM
Terminations	Termination Comments	Insert				7/11/2014 11:35 AM
Terminations	Termination Date	Insert				7/11/2014 11:35 AM
Terminations	Termination Effective Date	Insert				7/11/2014 11:35 AM
Terminations	Termination Reason	Insert				7/11/2014 11:35 AM