Covered Entity Details

DSH330196D CONEY ISLAND HOSPITAL (Terminated) - information as of 5/9/2025 10:50:17 PM

Main Details

Name

CONEY ISLAND HOSPITAL

Subdivision Name

Mobile Medical Office Van #2 / Podiatry and Ophthalmology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330196D

Medicare Provider Number

330196

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/30/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/12/2014

Last Recertification Date

8/15/2016

Termination Date
Termination Reason

1/1/2018
Site closure

Contacts

Authorizing Official

New York City Health and Hospitals
Paul Albertson, Vice President
(212) 748-2256

Primary Contact

New York City Health + Hospitals
Danielle Sestito, Senior Director, 340B Operations
(212) 442-3892

Addresses

Street Address

460 Brielle Ave
Staten Island, NY 10314

Billing Address

Coney Island Hospital
2601 Ocean Parkway
Brooklyn, NY 11235

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	00246066
		1124032982

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
DSH330196A	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	MARINERS HARBOR FAMILY HEALTH Center	2040 FOREST AVENUE	STATEN ISLAND	NY	Terminated
DSH330196B	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	STAPLETON Child Health Clinic	111 CANAL STREET	STATEN ISLAND	NY	Terminated
DSH330196C	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	HEALTH CONNECTION MOBILE MEDICAL OFFICE, C/O SEA VIEW HOSPITAL REHABILITATION CENTER AND HOME	460 BRIELLE AVENUE	STATEN ISLAND	NY	Terminated
DSH330196D	Child	DSH	CONEY ISLAND HOSPITAL	Mobile Medical Office Van #2 / Podiatry and Ophthalmology	460 Brielle Ave	Staten Island	NY	Terminated
DSH330196E	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel: Dental	2925 West 19th Street	Brooklyn	NY	Active
DSH330196F	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	Homecrest Health Center	1601 Ave S	Brooklyn	NY	Terminated
DSH330196G	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel: Chemical Dependency	2925 West 19th Street	Brooklyn	NY	Active
DSH330196H	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel: Primary Care Adults	2925 West 19th Street	Brooklyn	NY	Active
DSH330196J	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	IDA Israel: Pediatrics	2925 West 19th Street	Brooklyn	NY	Terminated
DSH330196K	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel Clinic: Family Planning	2925 West 19th Street	Brooklyn	NY	Active
DSH330196L	Child	DSH	CONEY ISLAND HOSPITAL	Mobile Medical Office Van #4	2925 West 19th Street	Brooklyn	NY	Terminated
DSH330196M	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	STAPLETON Child Health Clinic - PEDIATRICS	111 Canal Street	STATEN ISLAND	NY	Terminated
DSH330196N	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	MARINERS HARBOR FAMILY HEALTH CENTER - PEDIATRICS	2040 FOREST AVENUE	STATEN ISLAND	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/19/2017 12:00:00 AM	10/12/2017 1:13 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/12/2017 1:13 PM
Terminations	Termination Date	Update	Termination Request		1/1/2018 12:00:00 AM	10/12/2017 1:13 PM
Terminations	Termination Effective Date	Update	Termination Request		8/1/2017 12:00:00 AM	10/12/2017 1:13 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	10/12/2017 1:13 PM
Contacts	Primary Contact	Insert	Change Request		Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	10/4/2017 11:55 AM
Contacts	Authorizing Official	Update	Profile Change Request	Albertson, Paul Vice President Elmhurst Hospital 2127482256	Albertson, Paul Vice President New York City Health and Hospitals 2127482256	9/21/2017 5:59 PM
Contacts	Authorizing Official	Update	Change Request	Albertson, Paul Vice President 2127482256	Albertson, Paul Vice President Elmhurst Hospital 2127482256	9/20/2017 11:54 AM
Contacts	Authorizing Official	Insert			Albertson, Paul Vice President 2127482256	8/14/2017 11:29 AM
Contacts	Signed By	Insert			Martin, Antonio Ececutive Vice President & Chief Operating Officier 2127883479	8/14/2017 11:24 AM
Addresses	Main Address	Insert			460 Brielle Ave Staten Island, NY 10314	4/18/2017 7:34 AM
Addresses	Billing Address	Insert			Coney Island Hospital 2601 Ocean Parkway Brooklyn, NY 11235	4/18/2017 7:34 AM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 11:22 AM
Details	Entity Subname	Update		Staten Island Mobile Medical Office Van #2 / Podiatry and Ophthalmology	Mobile Medical Office Van #2 / Podiatry and Ophthalmology	12/28/2015 5:40 PM
Details	Last Recertification Date	Update			8/6/2015 12:00:00 AM	8/6/2015 9:50 AM
Details	Entity Subname	Update		Staten Island Mobile Medical Office Van #2	Staten Island Mobile Medical Office Van #2 / Podiatry and Ophthalmology	12/12/2014 8:17 AM
Dates	Participating Approval Date	Update			12/12/2014 12:00:00 AM	12/12/2014 8:17 AM
Details	State	Update		Pending	Active	12/12/2014 8:17 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/12/2014 8:17 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47965	DSH330196D	11/26/2014 1:07 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47965	10/30/2014 3:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/30/2014 3:57 PM
Medicaid Billing	Medicaid: Number	Insert			00246066	10/30/2014 3:57 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/30/2014 3:57 PM
Medicaid Billing	NPI: Number	Insert			1124032982	10/30/2014 3:57 PM
Details	Last Recertification Date	Insert				10/30/2014 3:57 PM
Details	Grant Number	Insert				10/30/2014 3:57 PM
Details	340B ID	Insert				10/30/2014 3:57 PM
Details	Is Authorizing Official EHB Data	Insert				10/30/2014 3:57 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/30/2014 3:57 PM
Details	Medicare Provider Number	Insert			330196	10/30/2014 3:57 PM
Details	Entity Name	Insert			CONEY ISLAND HOSPITAL	10/30/2014 3:57 PM
Details	Program Code	Insert			DSH	10/30/2014 3:57 PM
Details	Entity Subname	Insert			Staten Island Mobile Medical Office Van #2	10/30/2014 3:57 PM
Dates	Participating Approval Date	Insert				10/30/2014 3:57 PM
Details	State	Insert			Pending	10/30/2014 3:57 PM
Dates	Registration Date	Insert			10/30/2014 12:00:00 AM	10/30/2014 3:57 PM
Dates	Signed By Date	Insert			10/30/2014 12:00:00 AM	10/30/2014 3:57 PM
Dates	Start Date	Insert				10/30/2014 3:57 PM
Terminations	Termination Comments	Insert				10/30/2014 3:57 PM
Terminations	Termination Date	Insert				10/30/2014 3:57 PM
Terminations	Termination Effective Date	Insert				10/30/2014 3:57 PM
Terminations	Termination Reason	Insert				10/30/2014 3:57 PM