Covered Entity Details

DSH330196E NYC Health + Hospitals/South Brooklyn Health (Active) - information as of 6/9/2025 11:03:11 PM

Main Details

Name

NYC Health + Hospitals/South Brooklyn Health

Subdivision Name

Ida Israel: Dental

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330196E

Medicare Provider Number

330196

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/12/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/4/2015

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

NYC Health + Hospitals
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446

Primary Contact

NYC Health + Hospitals
Mark Capuano, Senior Director, Corporate Pharmacy 340B Program
(347) 835-9198

Addresses

Street Address

2925 West 19th Street
Brooklyn, NY 11224

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

Shipping Address 1

Coney Island Hospital
2601 Ocean Parkway
Brooklyn, NY 11235

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
Contacts	Authorizing Official	Update	Profile Change Request	Brown, Deborah Alyse Senior Vice President, External and Regulatory Affairs NYC Health + Hospitals 3479470446	Brown, Deborah Alyse Senior Vice President, Chief External Affairs Officer NYC Health + Hospitals 3479470446	11/15/2024 1:26 PM
Details	Last Recertification Date	Update	Recertification	8/29/2023 2:14:13 PM	9/3/2024 2:47:35 PM	9/3/2024 2:47 PM
Details	Last Recertification Date	Update	Recertification	9/2/2022 11:10:45 AM	8/29/2023 2:14:13 PM	8/29/2023 2:14 PM
Details	Entity Name	Update	Change Request	CONEY ISLAND HOSPITAL (NYCHHC)	NYC Health + Hospitals/South Brooklyn Health	2/8/2023 10:06 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 7:27:18 PM	9/2/2022 11:10:45 AM	9/2/2022 11:10 AM
Contacts	Primary Contact	Update	Group Change Request	Than, Min Assistant Vice President New York City Health and Hospitals 2124423854	Capuano, Mark Senior Director, Corporate Pharmacy 340B Program NYC Health + Hospitals 3478359198	8/23/2022 6:48 AM
Contacts	Authorizing Official	Update	AO Change Request	Albertson, Paul Vice President New York City Health and Hospitals 2127482256	Brown, Deborah Alyse Senior Vice President, External and Regulatory Affairs NYC Health + Hospitals 3479470446	8/22/2022 6:47 AM
Contacts	Primary Contact	Update	Profile Change Request	Than, Min Sr. Director New York City Health and Hospitals 2124423854	Than, Min Assistant Vice President New York City Health and Hospitals 2124423854	8/24/2021 6:37 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 11:31:53 AM	8/19/2021 7:27:18 PM	8/19/2021 7:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/4/2020 11:31 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 9:08:30 AM	9/4/2020 11:31:53 AM	9/4/2020 11:31 AM
Contacts	Primary Contact	Update	Change Request	Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	Than, Min Sr. Director New York City Health and Hospitals 2124423854	7/27/2020 8:14 AM
Details	Last Recertification Date	Update	Recertification	9/10/2018 1:22:32 AM	8/27/2019 9:08:30 AM	8/27/2019 9:08 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 10:07:39 PM	9/10/2018 1:22:32 AM	9/10/2018 1:22 AM
Addresses	Shipping Address	Insert	Recertification		Coney Island Hospital 2601 Ocean Parkway Brooklyn, NY 11235	11/15/2017 10:07 PM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/15/2017 10:07:39 PM	11/15/2017 10:07 PM
Contacts	Primary Contact	Insert	Change Request		Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	10/4/2017 11:58 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			2925 West 19th Street Brooklyn, NY 11224	4/18/2017 7:35 AM
Addresses	Billing Address	Insert			Coney Island Hospital 2601 Ocean Parkway Brooklyn, NY 11235	4/18/2017 7:35 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	Last Recertification Date	Update			8/6/2015 12:00:00 AM	8/6/2015 9:50 AM
Details	Entity Subname	Update		Ida Israel: Dental / Dental	Ida Israel: Dental	3/4/2015 5:13 PM
Dates	Participating Approval Date	Update			3/4/2015 12:00:00 AM	3/4/2015 5:01 PM
Details	State	Update		Pending	Active	3/4/2015 5:01 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/4/2015 5:01 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48684	DSH330196E	2/3/2015 12:55 PM
Medicaid Billing	NPI: Number	Insert			1124032982	1/12/2015 11:21 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48684	1/12/2015 11:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/12/2015 11:21 AM
Medicaid Billing	Medicaid: Number	Insert			00246066	1/12/2015 11:21 AM
Medicaid Billing	Medicaid: State	Insert			NY	1/12/2015 11:21 AM
Details	Last Recertification Date	Insert				1/12/2015 11:21 AM
Details	Grant Number	Insert				1/12/2015 11:21 AM
Details	340B ID	Insert				1/12/2015 11:21 AM
Details	Is Authorizing Official EHB Data	Insert				1/12/2015 11:21 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/12/2015 11:21 AM
Details	Medicare Provider Number	Insert			330196	1/12/2015 11:21 AM
Details	Entity Name	Insert			CONEY ISLAND HOSPITAL (NYCHHC)	1/12/2015 11:21 AM
Details	Program Code	Insert			DSH	1/12/2015 11:21 AM
Details	Entity Subname	Insert			Ida Israel: Dental / Dental	1/12/2015 11:21 AM
Dates	Participating Approval Date	Insert				1/12/2015 11:21 AM
Details	State	Insert			Pending	1/12/2015 11:21 AM
Dates	Registration Date	Insert			1/12/2015 12:00:00 AM	1/12/2015 11:21 AM
Dates	Signed By Date	Insert			1/12/2015 12:00:00 AM	1/12/2015 11:21 AM
Dates	Start Date	Insert				1/12/2015 11:21 AM
Terminations	Termination Comments	Insert				1/12/2015 11:21 AM
Terminations	Termination Date	Insert				1/12/2015 11:21 AM
Terminations	Termination Effective Date	Insert				1/12/2015 11:21 AM
Terminations	Termination Reason	Insert				1/12/2015 11:21 AM