Covered Entity Details

DSH330231H QUEENS HOSPITAL CENTER (NYCHHC) (Terminated) - information as of 4/26/2025 11:41:09 PM

Main Details

Name

QUEENS HOSPITAL CENTER (NYCHHC)

Subdivision Name

Queens Hospital Center Child & Adolescent OPD PS 154 Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330231H

Medicare Provider Number

330231

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/30/2014

Participating Start Date

1/1/2015

Participating Approval Date

11/21/2014

Last Recertification Date

8/28/2019

Termination Date
Termination Reason

1/1/2020
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

75-02 162nd Street
Flushing, NY 11366

Billing Address

Queens Hospital Center
82-68 164th Street
Jamaica, NY 11432

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	00246153
		1801803903

Shipping Addresses

Shipping Address 1

Queens Hospital Center
82-68 164th Street
Jamaica, NY 11432

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
DSH330231B	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	School Based Hospital Extension Clinic P.S. 86	87-41 Parsons Blvd.	Jamaica	NY	Terminated
DSH330231C	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Springfield Gardens Educational Campus	143-10 Springfield Gardens	Jamaica	NY	Terminated
DSH330231D	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Queens Health Net Springfield Gardens	134-64 Springfield Blvd	Springfield Gardens	NY	Terminated
DSH330231E	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Queens Geriatric Clinic Primary Care Clinic South Queens	114-02 Guy Brewer Blvd	Jamaica	NY	Terminated
DSH330231F	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Queens Geriatric Clinic Robert Couche Senior Citizen Center	137-57 Farmers Blvd	Jamaica	NY	Terminated
DSH330231G	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Queens Hospital Center Child & Adolescent OPD PS 160 Clinic	109-59 Inwood Street	Jamaica	NY	Terminated
DSH330231H	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Queens Hospital Center Child & Adolescent OPD PS 154 Clinic	75-02 162nd Street	Flushing	NY	Terminated
DSH330231J	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Queens Hospital Center Child & Adolescent OPD Jamaica High School Clinic	167-01 Gothic Drive	Jamaica	NY	Terminated
DSH330231K	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Primary Care Clinic	114-02 Guy Brewer Blvd	Jamaica	NY	Terminated
DSH330231L	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	Parsons Medical Center	90-37 Parsons Blvd	Jamaica	NY	Terminated
DSH330231M	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	QHC Assertive Community Treatment II	82-68 164th Street	Jamaica	NY	Terminated
DSH330231N	Child	DSH	QUEENS HOSPITAL CENTER (NYCHHC)	QHC Assertive Community Treatment I	82-68 164th Street	Jamaica	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/1/2019 12:00:00 AM	11/24/2019 8:46 PM
Details	State	Update	Termination Request	Active	To Be Terminated	11/24/2019 8:46 PM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	11/24/2019 8:46 PM
Terminations	Termination Effective Date	Update	Termination Request		7/1/2019 12:00:00 AM	11/24/2019 8:46 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	11/24/2019 8:46 PM
Details	Last Recertification Date	Update	Recertification	9/10/2018 1:26:04 AM	8/28/2019 7:26:34 AM	8/28/2019 7:26 AM
Details	Last Recertification Date	Update	Recertification	11/8/2017 1:18:58 PM	9/10/2018 1:26:04 AM	9/10/2018 1:26 AM
Details	Entity Name	Update	Recertification	QUEENS HOSPITAL CENTER	QUEENS HOSPITAL CENTER (NYCHHC)	11/8/2017 1:22 PM
Addresses	Shipping Address	Insert	Recertification		Queens Hospital Center 82-68 164th Street Jamaica, NY 11432	11/8/2017 1:18 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/8/2017 1:18:58 PM	11/8/2017 1:18 PM
Contacts	Primary Contact	Insert	Change Request		Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	10/4/2017 11:59 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	Update		Martin, Antonio Ececutive Vice President & Chief Operating Officier 2127883479	Albertson, Paul Vice President 2127482256	9/11/2017 3:29 PM
Contacts	Authorizing Official	Insert			Martin, Antonio Ececutive Vice President & Chief Operating Officier 2127883479	8/14/2017 11:24 AM
Contacts	Signed By	Insert			Martin, Antonio Ececutive Vice President & Chief Operating Officier 2127883479	8/14/2017 11:24 AM
Addresses	Main Address	Insert			75-02 162nd Street Flushing, NY 11366	4/20/2017 5:26 PM
Addresses	Billing Address	Insert			Queens Hospital Center 82-68 164th Street Jamaica, NY 11432	4/20/2017 5:26 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 8:24 AM
Details	Last Recertification Date	Update			8/5/2015 12:00:00 AM	8/5/2015 4:34 PM
Details	Entity Subname	Update		Queens School Based Mental Health PS 154	Queens Hospital Center Child & Adolescent OPD PS 154 Clinic	3/6/2015 4:09 PM
Dates	Participating Approval Date	Update			11/21/2014 12:00:00 AM	11/21/2014 4:10 PM
Details	State	Update		Pending	Active	11/21/2014 4:10 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	11/21/2014 4:10 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48014	DSH330231H	11/13/2014 3:38 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48014	10/30/2014 5:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/30/2014 5:36 PM
Medicaid Billing	Medicaid: Number	Insert			00246153	10/30/2014 5:36 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/30/2014 5:36 PM
Medicaid Billing	NPI: Number	Insert			1801803903	10/30/2014 5:36 PM
Details	Last Recertification Date	Insert				10/30/2014 5:36 PM
Details	Grant Number	Insert				10/30/2014 5:36 PM
Details	340B ID	Insert				10/30/2014 5:36 PM
Details	Is Authorizing Official EHB Data	Insert				10/30/2014 5:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/30/2014 5:36 PM
Details	Medicare Provider Number	Insert			330231	10/30/2014 5:36 PM
Details	Entity Name	Insert			QUEENS HOSPITAL CENTER	10/30/2014 5:36 PM
Details	Program Code	Insert			DSH	10/30/2014 5:36 PM
Details	Entity Subname	Insert			Queens School Based Mental Health PS 154	10/30/2014 5:36 PM
Dates	Participating Approval Date	Insert				10/30/2014 5:36 PM
Details	State	Insert			Pending	10/30/2014 5:36 PM
Dates	Registration Date	Insert			10/30/2014 12:00:00 AM	10/30/2014 5:36 PM
Dates	Signed By Date	Insert			10/30/2014 12:00:00 AM	10/30/2014 5:36 PM
Dates	Start Date	Insert				10/30/2014 5:36 PM
Terminations	Termination Comments	Insert				10/30/2014 5:36 PM
Terminations	Termination Date	Insert				10/30/2014 5:36 PM
Terminations	Termination Effective Date	Insert				10/30/2014 5:36 PM
Terminations	Termination Reason	Insert				10/30/2014 5:36 PM