Covered Entity Details

RRC330094-13 Columbia Memorial Hospital (Active) - information as of 4/25/2025 8:34:01 PM

Main Details

Name

Columbia Memorial Hospital

Subdivision Name

Valatie Rapid Care

Type

Rural Referral Center

Rural

Yes

340B ID

RRC330094-13

Medicare Provider Number

330094

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/14/2014

Participating Start Date

1/1/2015

Participating Approval Date

11/12/2014

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Columbia Memorial Hospital
Bryan T. Mahoney, Chief Financial Officer
(518) 697-3230

Primary Contact

Albany Med Health System
Alan W Slowick, System Associate Director of Pharmacy - 340B
(518) 926-2527

Addresses

Street Address

2827 Rt. 9
Valatie, NY 12184

Billing Address

Columbia Memorial Hospital
P.O. Box 2000
Hudson, NY 12534

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	03001118	1528024718

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
RRC330094-01	Child	RRC	Columbia Memorial Hospital	Valatie Medical Imaging	1301 River St	Valatie	NY	Active
RRC330094-02	Child	RRC	Columbia Memorial Hospital	Greene Medical Imaging	159 Jefferson Heights	Catskill	NY	Active
RRC330094-03	Child	RRC	Columbia Memorial Hospital	Women's Health Center - Catskill	159 Jefferson Heights	Catskill	NY	Active
RRC330094-04	Child	RRC	Columbia Memorial Hospital	Women's Health Center - Hudson	67 Prospect Ave	Hudson	NY	Active
RRC330094-05	Child	RRC	Columbia Memorial Hospital	Windham Medical Care	345 State Route 296	Hensonville	NY	Active
RRC330094-06	Child	RRC	Columbia Memorial Hospital	Valatie Family Care Center	2827 Rt. 9	Valatie	NY	Active
RRC330094-07	Child	RRC	Columbia Memorial Hospital	Twin County Sleep Lab - Ghent	2 Sherman Potts Drive, Rt. 66	Ghent	NY	Terminated
RRC330094-08	Child	RRC	Columbia Memorial Hospital	Twin County Nephrology - Catskill	159 Jefferson Heights	Catskill	NY	Active
RRC330094-09	Child	RRC	COLUMBIA MEMORIAL HOSPITAL	Twin County Nephrology - Hudson	71 Prospect Ave	Hudson	NY	Terminated
RRC330094-10	Child	RRC	Columbia Memorial Hospital	Twin County Cardiology - Catskill	159 Jefferson Heights	Catskill	NY	Active
RRC330094-11	Child	RRC	Columbia Memorial Hospital	Twin County Cardiology - Hudson	67 Prospect Ave	Hudson	NY	Active
RRC330094-12	Child	RRC	Columbia Memorial Hospital	Neurosurgery and Spine	71 Prospect Ave	Hudson	NY	Terminated
RRC330094-13	Child	RRC	Columbia Memorial Hospital	Valatie Rapid Care	2827 Rt. 9	Valatie	NY	Active
RRC330094-14	Child	RRC	Columbia Memorial Hospital	Prime Medical	159 Jefferson Heights	Catskill	NY	Active
RRC330094-15	Child	RRC	Columbia Memorial Hospital	Mountain View Medical Practice	159 Jefferson Heights	Catskill	NY	Terminated
RRC330094-16	Child	RRC	Columbia Memorial Hospital	Kinderhook Medical Care	2827 Rt. 9	Valatie	NY	Active
RRC330094-17	Child	RRC	Columbia Memorial Hospital	Jefferson Heights Family Care Center	159 Jefferson Heights	Catskill	NY	Active
RRC330094-18	Child	RRC	Columbia Memorial Hospital	Hudson Medical Care	67 Prospect Ave	Hudson	NY	Active
RRC330094-19	Child	RRC	COLUMBIA MEMORIAL HOSPITAL	Ghent Family Care	60 Garage Place Road	Ghent	NY	Terminated
RRC330094-20	Child	RRC	Columbia Memorial Hospital	Coxsackie Medical Care	9 Law Street	West Coxsackie	NY	Terminated
RRC330094-21	Child	RRC	Columbia Memorial Hospital	Columbia Urology	67 Prospect Ave	Hudson	NY	Active
RRC330094-22	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Surgical Associates	67 Prospect Ave	Hudson	NY	Active
RRC330094-23	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Rheumatology	23 Fish and Game Road	Hudson	NY	Active
RRC330094-24	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Pulmonology	67 Prospect Ave	Hudson	NY	Active
RRC330094-25	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Pediatrics - Hudson	813 Warren Street	Hudson	NY	Active
RRC330094-26	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Pain Management	67 Prospect Ave	Hudson	NY	Active
RRC330094-27	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Gastroenterology	67 Prospect Ave	Hudson	NY	Active
RRC330094-28	Child	RRC	COLUMBIA MEMORIAL HOSPITAL	Columbia Memorial Family Care - Catskill	159 Jefferson Heights	Catskill	NY	Terminated
RRC330094-29	Child	RRC	COLUMBIA MEMORIAL HOSPITAL	Columbia Memorial Family Care - Valatie	1301 River Street	Valatie	NY	Terminated
RRC330094-30	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Family Care - Hudson	67 Prospect Ave	Hudson	NY	Active
RRC330094-31	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Endocrinology	23 Fish & Game Rd	Hudson	NY	Terminated
RRC330094-32	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Cardiology	1301 River Street	Valatie	NY	Active
RRC330094-33	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Bone & Joint Center - Catskill	159 Jefferson Heights	Catskill	NY	Active
RRC330094-34	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Bone & Joint Center - Hudson	23 Fish and Game Road	Hudson	NY	Active
RRC330094-35	Child	RRC	COLUMBIA MEMORIAL HOSPITAL	Greene Medical Arts / Columbia Dermatology - Catskill	159 Jefferson Heights	Catskill	NY	Terminated
RRC330094-36	Child	RRC	COLUMBIA MEMORIAL HOSPITAL	Valatie Campus / Columbia Dermatology	2827 Rt. 9	Valatie	NY	Terminated
RRC330094-37	Child	RRC	Columbia Memorial Hospital	Chatham-Ghent Family Care Center	31 Dardess Drive	Chatham	NY	Active
RRC330094-38	Child	RRC	Columbia Memorial Hospital	Callan Family Care Center	283 Mountain View Road	Copake	NY	Active
RRC330094-39	Child	RRC	Columbia Memorial Hospital	Cairo Family Care Center	4383 Rt. 23	Cairo	NY	Active
RRC330094-40	Child	RRC	Columbia Memorial Hospital	Broadway Family Care Center	17 Glen Pond Drive	Red Hook	NY	Active
RRC330094-41	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Hospital Rehabilitation Services - Occupational Therapy	23 Fish and Game Road	Hudson	NY	Active
RRC330094-42	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Hospital Rehabilitation Services - Physical Therapy	23 Fish and Game Road	Hudson	NY	Active
RRC330094-43	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Physical Therapy - Greene	159 Jefferson Heights	Catskill	NY	Active
RRC330094-44	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Psychiatric and Psychotherapy Center - Catskill	159 Jefferson Heights	Catskill	NY	Active
RRC330094-45	Child	RRC	Columbia Memorial Hospital	Medication Assisted Treatment Services	71 Prospect Ave	Hudson	NY	Terminated
RRC330094-46	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Breast and Vein Care	71 Prospect Ave	Hudson	NY	Terminated
RRC330094-47	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Pediatrics - Catskill	159 Jefferson Heights	Catskill	NY	Active
RRC330094-48	Child	RRC	Columbia Memorial Hospital	Prime Medical - Hudson	71 Prospect Ave	Hudson	NY	Terminated
RRC330094-49	Child	RRC	Columbia Memorial Hospital	Columbia Memorial Psychiatric and Psychotherapy Center - Hudson	71 Prospect Ave	Hudson	NY	Active
RRC330094-50	Child	RRC	Columbia Memorial Hospital	Copake Rapid Care	283 Mountain View Road	Copake	NY	Active
RRC330094-51	Child	RRC	Columbia Memorial Hospital	Women's Specialty Services	67 Prospect Ave	Hudson	NY	Active
RRC330094-52	Child	RRC	Columbia Memorial Hospital	Mountain View Medical Practice - Family Care	159 Jefferson Heights	Catskill	NY	Active
RRC330094-53	Child	RRC	Columbia Memorial Hospital	Valatie Pediatrics - Pediatrics	2827 Rt. 9	Valatie	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 2:46:09 PM	8/29/2024 12:31:14 PM	8/29/2024 12:31 PM
Contacts	Primary Contact	Update	Profile Change Request	Slowick, Alan W System Associate Director of Pharmacy - 340B Glens Falls Hospital 5189261000	Slowick, Alan W System Associate Director of Pharmacy - 340B Albany Med Health System 5189262527	12/20/2023 8:08 AM
Contacts	Primary Contact	Update	Profile Change Request	Slowick, Alan W 340B Program Manager Glens Falls Hospital 5189262527	Slowick, Alan W System Associate Director of Pharmacy - 340B Glens Falls Hospital 5189261000	10/31/2023 8:49 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 9:44:16 AM	9/5/2023 2:46:09 PM	9/5/2023 2:46 PM
Contacts	Primary Contact	Update	Group Change Request	Barrett, Kelly Manager of Financial Planning Columbia Memorial Hospital 5188288121	Slowick, Alan W 340B Program Manager Glens Falls Hospital 5189262527	1/6/2023 7:15 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 1:22:38 PM	9/14/2022 9:44:16 AM	9/14/2022 9:44 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 12:00:51 AM	8/30/2021 1:22:38 PM	8/30/2021 1:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		03001118	9/3/2020 12:00 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/3/2020 12:00 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1528024718	9/3/2020 12:00 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/3/2020 12:00 AM
Details	Last Recertification Date	Update	Recertification	9/5/2019 3:23:18 PM	9/3/2020 12:00:51 AM	9/3/2020 12:00 AM
Contacts	Primary Contact	Update	Profile Change Request	Barrett, Kelly Financial Analyst Columbia Memorial Hospital 5188288121	Barrett, Kelly Manager of Financial Planning Columbia Memorial Hospital 5188288121	9/1/2020 3:47 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 1:13:26 AM	9/5/2019 3:23:18 PM	9/5/2019 3:23 PM
Details	Last Recertification Date	Update	Recertification	11/21/2017 3:03:08 PM	8/17/2018 1:13:26 AM	8/17/2018 1:13 AM
Details	Entity Name	Update	Recertification	COLUMBIA MEMORIAL HOSPITAL	Columbia Memorial Hospital	11/29/2017 10:07 PM
Addresses	Billing Address	Insert	Recertification		Columbia Memorial Hospital P.O. Box 2000 Hudson, NY 12534	11/21/2017 3:03 PM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/21/2017 3:03:08 PM	11/21/2017 3:03 PM
Contacts	Authorizing Official	Update	Profile Change Request	Mahoney, Bryan T. Chief Financial Officer Columbia Memorial Hospital 5188287601-8249	Mahoney, Bryan T. Chief Financial Officer Columbia Memorial Hospital 5186973230	11/17/2017 11:27 AM
Contacts	Authorizing Official	Update		Mahoney, Bryan T. Chief Financial Officer 5188287601-8249	Mahoney, Bryan T. Chief Financial Officer Columbia Memorial Hospital 5188287601-8249	9/19/2017 1:58 PM
Contacts	Primary Contact	Update		Barrett, Kelly Financial Analyst 5188288121	Barrett, Kelly Financial Analyst Columbia Memorial Hospital 5188288121	9/19/2017 11:32 AM
Contacts	Primary Contact	Insert			Barrett, Kelly Financial Analyst 5188288121	8/11/2017 11:41 AM
Contacts	Authorizing Official	Insert			Mahoney, Bryan T. Chief Financial Officer 5188287601-8249	8/11/2017 11:41 AM
Contacts	Signed By	Insert			Dingman III, Vincent J. Chief Financial Officer 5188287601-8249	8/11/2017 11:41 AM
Addresses	Main Address	Insert			2827 Rt. 9 Valatie, NY 12184	8/23/2016 10:37 AM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 5:58 PM
Details	Last Recertification Date	Update			8/12/2015 12:00:00 AM	8/12/2015 1:53 PM
Dates	Participating Approval Date	Update			11/12/2014 12:00:00 AM	11/12/2014 4:11 AM
Details	State	Update		Pending	Active	11/12/2014 4:11 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	11/12/2014 4:11 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47302	RRC330094-13	10/27/2014 10:24 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47302	10/14/2014 1:21 PM
Details	Last Recertification Date	Insert				10/14/2014 1:21 PM
Details	Grant Number	Insert				10/14/2014 1:21 PM
Details	340B ID	Insert				10/14/2014 1:21 PM
Details	Is Authorizing Official EHB Data	Insert				10/14/2014 1:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2014 1:21 PM
Details	Medicare Provider Number	Insert			330094	10/14/2014 1:21 PM
Details	Entity Name	Insert			COLUMBIA MEMORIAL HOSPITAL	10/14/2014 1:21 PM
Details	Program Code	Insert			RRC	10/14/2014 1:21 PM
Details	Entity Subname	Insert			Valatie Rapid Care	10/14/2014 1:21 PM
Dates	Participating Approval Date	Insert				10/14/2014 1:21 PM
Details	State	Insert			Pending	10/14/2014 1:21 PM
Dates	Registration Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 1:21 PM
Dates	Signed By Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 1:21 PM
Dates	Start Date	Insert				10/14/2014 1:21 PM
Terminations	Termination Comments	Insert				10/14/2014 1:21 PM
Terminations	Termination Date	Insert				10/14/2014 1:21 PM
Terminations	Termination Effective Date	Insert				10/14/2014 1:21 PM
Terminations	Termination Reason	Insert				10/14/2014 1:21 PM