Covered Entity Details

DSH330215E Rome Memorial Hospital, Inc. (Active) - information as of 4/25/2025 8:34:36 PM

Main Details

Name

Rome Memorial Hospital, Inc.

Subdivision Name

DELTA MEDICAL

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330215E

Medicare Provider Number

330215

Outpatient Facility Provider Number

330215

Additional Details

Current Program Status

Active

Registration Date

7/15/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/8/2014

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Rome Health
Nathan Smith, AVP Finance
(315) 338-7597

Primary Contact

Rome Health
Tabatha Cingranelli, Controller
(315) 338-7275

Addresses

Street Address

1819 BLACK RIVER N BLVD
ROME, NY 13440-2451

Billing Address

Rome Memorial Hospital, Inc.
1500 North James Street
Rome, NY 13440

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

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
DSH330215A	Child	DSH	Rome Memorial Hospital, Inc.	OB Clinic	155 West Dominick Street	Rome	NY	Active
DSH330215B	Child	DSH	Rome Memorial Hospital, Inc.	Boonville Family Care	13407 State Route 12	Boonville	NY	Active
DSH330215C	Child	DSH	Rome Memorial Hospital, Inc.	Chestnut Commons Physical Therapy	107 E. Chestnut Street	Rome	NY	Active
DSH330215D	Child	DSH	Rome Memorial Hospital, Inc.	Camden Family Care	5 MASONIC AVE	CAMDEN	NY	Active
DSH330215E	Child	DSH	Rome Memorial Hospital, Inc.	DELTA MEDICAL	1819 BLACK RIVER N BLVD	ROME	NY	Active
DSH330215F	Child	DSH	Rome Memorial Hospital, Inc.	RMH REGIONAL CENTER FOR WOUND CARE	267 Avery Lane	ROME	NY	Active
DSH330215G	Child	DSH	Rome Memorial Hospital, Inc.	Community Recovery Center	107 E. Chestnut Street	Rome	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 8:54:02 AM	8/15/2024 11:01:16 AM	8/15/2024 11:01 AM
Contacts	Authorizing Official	Update	Profile Change Request	Smith, Nathan Controller Rome Health 3153387597	Smith, Nathan AVP Finance Rome Health 3153387597	8/13/2024 3:43 PM
Contacts	Primary Contact	Update	Profile Change Request	Cingranelli, Tabatha Finance Manager Rome Health 3153387275	Cingranelli, Tabatha Controller Rome Health 3153387275	8/12/2024 8:38 AM
Contacts	Authorizing Official	Update	Change Request	Rowlands, Dewey Vice President/Chief Financial Officer Rome Memorial Hospital 3153387024	Smith, Nathan Controller Rome Health 3153387597	3/21/2024 6:27 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 11:51:39 AM	8/15/2023 8:54:02 AM	8/15/2023 8:54 AM
Details	Last Recertification Date	Update	Recertification	8/27/2021 2:23:53 PM	8/26/2022 11:51:39 AM	8/26/2022 11:51 AM
Contacts	Primary Contact	Update	Change Request	Vinci, Ashley Director-Patient Accounting Rome Memorial Hospital 3153387358	Cingranelli, Tabatha Finance Manager Rome Health 3153387275	12/10/2021 9:34 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 7:31:20 AM	8/27/2021 2:23:53 PM	8/27/2021 2:23 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 7:42:23 AM	8/28/2020 7:31:20 AM	8/28/2020 7:31 AM
Details	Last Recertification Date	Update	Recertification	8/15/2018 12:43:25 PM	8/20/2019 7:42:23 AM	8/20/2019 7:42 AM
Addresses	Billing Address	Insert	Recertification		Rome Memorial Hospital, Inc. 1500 North James Street Rome, NY 13440	8/15/2018 12:43 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 2:19:34 PM	8/15/2018 12:43:25 PM	8/15/2018 12:43 PM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	11/6/2017 2:19:34 PM	11/6/2017 2:19 PM
Contacts	Primary Contact	Update	Recertification	Vinci, Ashley Manager, Reimbursement 3153387228	Vinci, Ashley Director-Patient Accounting Rome Memorial Hospital 3153387358	11/6/2017 2:12 PM
Contacts	Authorizing Official	Update		Rowlands, Dewey Vice President/Chief Financial Officer 3153387024	Rowlands, Dewey Vice President/Chief Financial Officer Rome Memorial Hospital 3153387024	10/16/2017 10:56 AM
Contacts	Signed By	Update		Rowlands, Dewey Vice President/Chief Financial Officer 3153387024	Rowlands, Dewey Vice President/Chief Financial Officer Rome Memorial Hospital 3153387024	10/16/2017 10:56 AM
Contacts	Primary Contact	Insert			Vinci, Ashley Manager, Reimbursement 3153387228	3/24/2017 1:11 PM
Contacts	Authorizing Official	Insert			Rowlands, Dewey Vice President/Chief Financial Officer 3153387024	3/24/2017 1:11 PM
Contacts	Signed By	Insert			Rowlands, Dewey Vice President/Chief Financial Officer 3153387024	3/24/2017 1:11 PM
Addresses	Main Address	Insert			1819 BLACK RIVER N BLVD ROME, NY 13440-2451	8/12/2016 8:26 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/12/2016 12:00:00 AM	8/12/2016 8:26 AM
Details	Last Recertification Date	Update			8/5/2015 12:00:00 AM	8/5/2015 10:32 AM
Dates	Participating Approval Date	Update			9/8/2014 12:00:00 AM	9/8/2014 10:20 AM
Details	State	Update		Pending	Active	9/8/2014 10:20 AM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/8/2014 10:20 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_46046	DSH330215E	9/5/2014 3:50 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_46046	7/15/2014 3:57 PM
Details	Last Recertification Date	Insert				7/15/2014 3:57 PM
Details	Grant Number	Insert				7/15/2014 3:57 PM
Details	340B ID	Insert				7/15/2014 3:57 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2014 3:57 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2014 3:57 PM
Details	Medicare Provider Number	Insert			330215	7/15/2014 3:57 PM
Details	Entity Name	Insert			Rome Memorial Hospital, Inc.	7/15/2014 3:57 PM
Details	Program Code	Insert			DSH	7/15/2014 3:57 PM
Details	Entity Subname	Insert			DELTA MEDICAL	7/15/2014 3:57 PM
Dates	Participating Approval Date	Insert				7/15/2014 3:57 PM
Details	State	Insert			Pending	7/15/2014 3:57 PM
Dates	Registration Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 3:57 PM
Dates	Signed By Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 3:57 PM
Dates	Start Date	Insert				7/15/2014 3:57 PM
Terminations	Termination Comments	Insert				7/15/2014 3:57 PM
Terminations	Termination Date	Insert				7/15/2014 3:57 PM
Terminations	Termination Effective Date	Insert				7/15/2014 3:57 PM
Terminations	Termination Reason	Insert				7/15/2014 3:57 PM