Covered Entity Details

DSH330395C EPISCOPAL HEALTH SERVICES INC (Active) - information as of 6/27/2025 12:27:20 AM

Main Details

Name

EPISCOPAL HEALTH SERVICES INC

Subdivision Name

Community Day Treatment Program

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330395C

Medicare Provider Number

330395

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2015

Participating Start Date

1/1/2016

Participating Approval Date

11/24/2015

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

St. John's Episcopal
Donald Morrish, Chief Executive Officer
(718) 869-7321

Primary Contact

St.John's Episcopal
Karen Muir, Chief Pharmacy Officer
(718) 869-7180

Addresses

Street Address

1908 Brookhaven Avenue
Far Rockaway, NY 11691

Billing Address
Same as Street Address

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	00729382,03005612,05606331	1346274537,1700049145,1689151201

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
DSH330395A	Child	DSH	EPISCOPAL HEALTH SERVICES INC	St. John's Episcopal Ambulatory Care Center / Pediatric and ENT	495 Beach 20th Street	Far Rockaway	NY	Active
DSH330395B	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Community Mental Health Clinic	521 Beach 20th Street	Far Rockaway	NY	Active
DSH330395C	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Community Day Treatment Program	1908 Brookhaven Avenue	Far Rockaway	NY	Active
DSH330395D	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Clinical Learning Center - Ambulatory Care Clinics	19-09 Plainview ave	Queens	NY	Active
DSH330395E	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Margaret O. Carpenter Women's Health Center - Women's Health	105-20 Rockaway Beach	Queens	NY	Active
DSH330395F	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Ambulatory Pavilion - Radiation Oncology	19-20 Brookhaven avenue	Queens	NY	Active
DSH330395G	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Ambulatory Pavilion - OB/GYN	19-20 Brookhaven	Queens	NY	Active
DSH330395H	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Ambulatory Pavilion - Oncology	19-20 Brookhaven Avenue	Queens	NY	Active
DSH330395J	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Ambulatory Pavilion - Endoscopy	19-20 Brookhaven Avenue	Queens	NY	Active
DSH330395K	Child	DSH	EPISCOPAL HEALTH SERVICES INC	Ambulatory Pavilion - Primary Care	19-20 Brookhaven Avenue	Queens	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Muir, Karen Director of Pharmacy St.John's Episcopal 7188697180	Muir, Karen Chief Pharmacy Officer St.John's Episcopal 7188697180	2/19/2025 4:02 PM
Contacts	Authorizing Official	Update	Profile Change Request	Morrish, Donald Chief Executive Officer St. John's Episcopal 7188695760	Morrish, Donald Chief Executive Officer St. John's Episcopal 7188697321	1/17/2025 2:13 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 2:09:02 PM	8/14/2024 9:22:18 AM	8/14/2024 9:22 AM
Contacts	Authorizing Official	Update	Change Request	Walsh, Gerard M. CEO St. John's Episcopal 7188697320	Morrish, Donald Chief Executive Officer St. John's Episcopal 7188695760	3/21/2024 12:42 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 2:49:53 PM	8/22/2023 2:09:02 PM	8/22/2023 2:09 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 10:37:26 AM	8/26/2022 2:49:53 PM	8/26/2022 2:49 PM
Details	Last Recertification Date	Update	Recertification	9/1/2020 1:23:43 PM	8/23/2021 10:37:26 AM	8/23/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		00729382	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		03005612	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		05606331	9/1/2020 1:23 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/1/2020 1:23 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1700049145	9/1/2020 1:23 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/1/2020 1:23 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1689151201	9/1/2020 1:23 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/1/2020 1:23 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 1:23 PM
Details	Last Recertification Date	Update	Recertification	8/19/2019 2:30:42 PM	9/1/2020 1:23:43 PM	9/1/2020 1:23 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 2:22:51 PM	8/19/2019 2:30:42 PM	8/19/2019 2:30 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 10:35:42 AM	8/17/2018 2:22:51 PM	8/17/2018 2:22 PM
Details	Entity Name	Update	Recertification	EPISCOPAL HEALTH SERVICES	EPISCOPAL HEALTH SERVICES INC	11/8/2017 1:38 PM
Details	Last Recertification Date	Update	Recertification	10/25/2017 12:29:45 PM	11/6/2017 10:35:42 AM	11/6/2017 10:35 AM
Contacts	Primary Contact	Insert	Recertification		Muir, Karen Director of Pharmacy St.John's Episcopal 7188697180	10/25/2017 12:29 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	10/25/2017 12:29:45 PM	10/25/2017 12:29 PM
Contacts	Authorizing Official	Update		Walsh, Gerard M. CEO 7188697320	Walsh, Gerard M. CEO St. John's Episcopal 7188697320	10/25/2017 12:20 PM
Contacts	Signed By	Update		Walsh, Gerard M. CEO 7188697320	Walsh, Gerard M. CEO St. John's Episcopal 7188697320	10/25/2017 12:20 PM
Contacts	Authorizing Official	Insert			Walsh, Gerard M. CEO 7188697320	4/26/2017 3:30 PM
Contacts	Signed By	Insert			Walsh, Gerard M. CEO 7188697320	4/26/2017 3:30 PM
Addresses	Main Address	Insert			1908 Brookhaven Avenue Far Rockaway, NY 11691	8/23/2016 11:00 AM
Details	Last Recertification Date	Update			8/23/2016 12:00:00 AM	8/23/2016 11:00 AM
Dates	Participating Approval Date	Update			11/24/2015 12:00:00 AM	11/24/2015 10:53 AM
Details	State	Update		Pending	Active	11/24/2015 10:53 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	11/24/2015 10:53 AM
Details	340B ID	Update		DEL_10162015_56147	DSH330395C	11/24/2015 9:00 AM
Details	State	Update		Rejected	Pending	11/24/2015 9:00 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_56147	DEL_10162015_56147	10/16/2015 9:23 AM
Details	State	Update		Pending	Rejected	10/16/2015 9:23 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_56147	10/15/2015 4:18 PM
Medicaid Billing	NPI: Number	Insert			1346274537	10/15/2015 4:18 PM
Details	Last Recertification Date	Insert				10/15/2015 4:18 PM
Details	Grant Number	Insert				10/15/2015 4:18 PM
Details	340B ID	Insert				10/15/2015 4:18 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2015 4:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2015 4:18 PM
Details	Medicare Provider Number	Insert			330395	10/15/2015 4:18 PM
Details	Entity Name	Insert			EPISCOPAL HEALTH SERVICES	10/15/2015 4:18 PM
Details	Program Code	Insert			DSH	10/15/2015 4:18 PM
Details	Entity Subname	Insert			Community Day Treatment Program	10/15/2015 4:18 PM
Dates	Participating Approval Date	Insert				10/15/2015 4:18 PM
Details	State	Insert			Pending	10/15/2015 4:18 PM
Dates	Registration Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 4:18 PM
Dates	Signed By Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 4:18 PM
Dates	Start Date	Insert				10/15/2015 4:18 PM
Terminations	Termination Comments	Insert				10/15/2015 4:18 PM
Terminations	Termination Date	Insert				10/15/2015 4:18 PM
Terminations	Termination Effective Date	Insert				10/15/2015 4:18 PM
Terminations	Termination Reason	Insert				10/15/2015 4:18 PM