Covered Entity Details

DSH330188H Mount St. Mary's Hospital and Health Center (Terminated) - information as of 6/24/2025 12:01:17 AM

Main Details

Name

Mount St. Mary's Hospital and Health Center

Subdivision Name

Primary Care - Colomba

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330188H

Medicare Provider Number

330188

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/15/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/16/2016

Last Recertification Date

8/29/2023

Termination Date
Termination Reason

10/1/2024
Site closure

Contacts

Authorizing Official

Catholic Health System
Michael Osborne, Vice President, Finance
(716) 828-2011

Primary Contact

Catholic Health System
Tristan Diane Greer, 340B Program Business Manager
(716) 923-2920

Addresses

Street Address

1 Colomba Drive
Suite 2
Niagara Falls, NY 14305-1275

Billing Address

Mount St. Mary's Hospital and Health Center c/o Catholic Health
144 Genesee Street
4th Floor
Buffalo, NY 14203-1997

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	01746616	1043394745

Shipping Addresses

Shipping Address 1

Mount St. Mary's Hospital
5300 Military Road
Lewiston, NY 14092

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
Contract Detail	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	06/27/2018	07/01/2018	07/01/2018	10/01/2024	10/01/2024
Contract Detail	CATHOLIC HEALTH SYSTEM INFUSION PHARMACY	D/B/A CATHOLIC HEALTH INFUSION PHARMACY	6350 TRANSIT RD	DEPEW	NY	14043	06/27/2018	07/01/2018	07/01/2018	10/01/2024	10/01/2024
Contract Detail	CATHOLIC HEALTH SYSTEM INFUSION PHARMACY	CATHOLIC HEALTH RX AT SISTERS HOSPITAL	2157 MAIN ST	BUFFALO	NY	14214-2648	03/09/2022	04/01/2022	04/01/2022	10/01/2024	10/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330188A	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - EMERGENCY	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AA	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - URGENT CARE	5875 S Transit Road	Lockport	NY	Active
DSH330188AC	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - ANESTHESIA	5875 S Transit Road	Lockport	NY	Active
DSH330188AD	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - MAIN OR/GI	5875 S Transit Road	Lockport	NY	Active
DSH330188AE	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - ULTRASOUND	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AF	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - NON-INVASIVE CARDIOLOGY PROC	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AG	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - CT SCAN	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AH	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - MED SURG	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188AJ	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - Prep/ Recovery	5875 S Transit Road	Lockport	NY	Active
DSH330188B	Child	DSH	Mount St. Mary's Hospital and Health Center	NEIGHBORHOOD HEALTH CENTER	3101 NINTH STREET	NIAGARA FALLS	NY	Active
DSH330188C	Child	DSH	Mount St. Mary's Hospital and Health Center	SPECIALTY MEDICAL SERVICES	5320 Military Road, Suite 107	Lewiston	NY	Terminated
DSH330188D	Child	DSH	Mount St. Mary's Hospital and Health Center	EAR, NOSE, & THROAT SERVICES	6941 ELAINE DRIVE	NIAGARA FALLS	NY	Active
DSH330188E	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Orthopedic Services	5320 Military Road, Suite 107	Lewiston	NY	Active
DSH330188F	Child	DSH	Mount St. Mary's Hospital and Health Center	Clinic for Complete Senior Care Center	1302 Main Street	Niagara Falls	NY	Active
DSH330188G	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care	5290 Military Road	Lewiston	NY	Active
DSH330188H	Child	DSH	Mount St. Mary's Hospital and Health Center	Primary Care - Colomba	1 Colomba Drive	Niagara Falls	NY	Terminated
DSH330188J	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Surgical Services	5320 Military Road	Lewiston	NY	Active
DSH330188K	Child	DSH	Mount St. Mary's Hospital and Health Center	MOUNT ST MARY'S NEUROLOGY AND STROKE	4600 MILITARY RD	NIAGARA FALLS	NY	Active
DSH330188L	Child	DSH	Mount St. Mary's Hospital and Health Center	Cardiac Center - Cardiopulmonary	5290 Military Road	Lewiston	NY	Active
DSH330188M	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Neurology Clinic - Neurology	5290 Military Road	Lewiston	NY	Active
DSH330188N	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Infectious Disease - Infectious Disease	5290 Military Road	Lewiston	NY	Active
DSH330188P	Child	DSH	Mount St. Mary's Hospital and Health Center	Neighborhood Health Center - Pediatrics - Pediatrics	3101 Ninth Street	Niagara Falls	NY	Active
DSH330188Q	Child	DSH	Mount St. Mary's Hospital and Health Center	Neighborhood Health Center - Women's Services - Women's Services	3101 Ninth Street	Niagara Falls	NY	Active
DSH330188R	Child	DSH	Mount St. Mary's Hospital and Health Center	MSM HEALTH CENTER LOCKPORT - HEALTH CENTER	6000 BROCKTON DR	LOCKPORT	NY	Terminated
DSH330188S	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Upper - Primary Care	5290 Military Road	Lewiston	NY	Active
DSH330188T	Child	DSH	Mount St. Mary's Hospital and Health Center	Mount St. Mary's Primary Care - Endocrinology - Endocrinology	5290 Military Road	Lewiston	NY	Active
DSH330188U	Child	DSH	Mount St. Mary's Hospital and Health Center	Lockport Memorial Hospital - Multispecialty HOD - Multispecialty HOD	6001 Shimer Drive	Lockport	NY	Active
DSH330188V	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - Breast Imaging	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188W	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - EMERGENCY	5875 S Transit Road	Lockport	NY	Active
DSH330188X	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - MRI	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188Y	Child	DSH	Mount St. Mary's Hospital and Health Center	LOCKPORT MEMORIAL HOSPITAL - NUCLEAR MEDICINE	6001 SHIMER DR	LOCKPORT	NY	Active
DSH330188Z	Child	DSH	Mount St. Mary's Hospital and Health Center	NIAGARA AMBULATORY SURGERY CENTER - CT SCAN	5875 S Transit Road	Lockport	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		8/1/2024 12:00:00 AM	9/3/2024 2:52 PM
Details	State	Update	Recertification	Active	To Be Terminated	9/3/2024 2:52 PM
Terminations	Termination Date	Update	Recertification		10/1/2024 12:00:00 AM	9/3/2024 2:52 PM
Terminations	Termination Effective Date	Update	Recertification		8/1/2024 12:00:00 AM	9/3/2024 2:52 PM
Terminations	Termination Reason	Update	Recertification		Site closure	9/3/2024 2:52 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 11:28:56 AM	8/29/2023 2:06:23 PM	8/29/2023 2:06 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 1:27:42 PM	8/29/2022 11:28:56 AM	8/29/2022 11:28 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 11:45:58 AM	8/16/2021 1:27:42 PM	8/16/2021 1:27 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	7188600 (FL)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	003101788A (GA)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	161523353001 (IL)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	7100203210 (KY)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1043394745 (MI)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	60058968 (NJ)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	8965150001 (PA)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	11488B (SC)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	161523353000 (OH)		9/11/2020 11:45 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	161523353 (WI)		9/11/2020 11:45 AM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/11/2020 11:45 AM
Details	Last Recertification Date	Update	Recertification	9/4/2019 2:03:42 PM	9/11/2020 11:45:58 AM	9/11/2020 11:45 AM
Contacts	Primary Contact	Update	Recertification	Shuldman, Dorothy 340B Program Business Manager Catholic Health System 7169232920	Greer, Tristan Diane 340B Program Business Manager Catholic Health System 7169232920	9/4/2019 2:03 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 9:50:53 AM	9/4/2019 2:03:42 PM	9/4/2019 2:03 PM
Contacts	Primary Contact	Update	Profile Change Request	Shuldman, Dorothy 340B Program Coordinator Catholic Health System 7169232920	Shuldman, Dorothy 340B Program Business Manager Catholic Health System 7169232920	10/24/2018 9:11 AM
Details	Last Recertification Date	Update	Recertification	11/16/2017 11:29:27 AM	8/15/2018 9:50:53 AM	8/15/2018 9:50 AM
Details	Entity Name	Update	Recertification	MOUNT ST. MARYS HOSPITAL	Mount St. Mary's Hospital and Health Center	11/16/2017 11:37 AM
Details	Last Recertification Date	Update	Recertification		11/16/2017 11:29:27 AM	11/16/2017 11:29 AM
Contacts	Authorizing Official	Update		Osborne, Michael Vice President, Finance 7168282011	Osborne, Michael Vice President, Finance Catholic Health System 7168282011	9/27/2017 4:33 PM
Contacts	Primary Contact	Update		Shuldman, Dorothy 340B Program Coordinator 7169232920	Shuldman, Dorothy 340B Program Coordinator Catholic Health System 7169232920	9/21/2017 9:03 AM
Contacts	Authorizing Official	Insert			Osborne, Michael Vice President, Finance 7168282011	8/10/2017 11:11 AM
Contacts	Primary Contact	Update		Volz, Laura Director of Pharmacy 7162982244	Shuldman, Dorothy 340B Program Coordinator 7169232920	8/10/2017 11:11 AM
Contacts	Signed By	Insert			TUCKER, GARY PRESIDENT/CEO 7162982004	8/10/2017 11:10 AM
Addresses	Main Address	Insert			1 Colomba Drive Suite 2 Niagara Falls, NY 14305-1275	8/10/2017 11:10 AM
Addresses	Billing Address	Insert			Mount St. Mary's Hospital and Health Center c/o Catholic Health 144 Genesee Street 4th Floor Buffalo, NY 14203-1997	8/10/2017 11:10 AM
Addresses	Shipping Address	Insert			Mount St. Mary's Hospital 5300 Military Road Lewiston, NY 14092	8/10/2017 11:10 AM
Contacts	Primary Contact	Insert			Volz, Laura Director of Pharmacy 7162982244	7/25/2017 7:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			7188600	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			FL	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			003101788A	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			GA	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			161523353001	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			IL	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			7100203210	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			KY	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			1043394745	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			MI	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			60058968	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			NJ	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			8965150001	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			PA	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			11488B	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			SC	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			161523353000	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			OH	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			161523353	7/25/2017 7:32 AM
Medicaid Billing	Medicaid: State	Insert			WI	7/25/2017 7:32 AM
Dates	Participating Approval Date	Update			8/16/2016 12:00:00 AM	8/16/2016 12:47 PM
Details	State	Update		Pending	Active	8/16/2016 12:47 PM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/16/2016 12:47 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72024	DSH330188H	8/2/2016 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/15/2016 2:58 PM
Medicaid Billing	Medicaid: Number	Insert			01746616	7/15/2016 2:58 PM
Medicaid Billing	Medicaid: State	Insert			NY	7/15/2016 2:58 PM
Medicaid Billing	NPI: Number	Insert			1043394745	7/15/2016 2:58 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72024	7/15/2016 2:58 PM
Details	Last Recertification Date	Insert				7/15/2016 2:58 PM
Details	Grant Number	Insert				7/15/2016 2:58 PM
Details	340B ID	Insert				7/15/2016 2:58 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2016 2:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2016 2:58 PM
Details	Medicare Provider Number	Insert			330188	7/15/2016 2:58 PM
Details	Entity Name	Insert			MOUNT ST. MARYS HOSPITAL	7/15/2016 2:58 PM
Details	Program Code	Insert			DSH	7/15/2016 2:58 PM
Details	Entity Subname	Insert			Primary Care - Colomba	7/15/2016 2:58 PM
Dates	Participating Approval Date	Insert				7/15/2016 2:58 PM
Details	State	Insert			Pending	7/15/2016 2:58 PM
Dates	Registration Date	Insert			7/15/2016 12:00:00 AM	7/15/2016 2:58 PM
Dates	Signed By Date	Insert			7/15/2016 12:00:00 AM	7/15/2016 2:58 PM
Dates	Start Date	Insert				7/15/2016 2:58 PM
Terminations	Termination Comments	Insert				7/15/2016 2:58 PM
Terminations	Termination Date	Insert				7/15/2016 2:58 PM
Terminations	Termination Effective Date	Insert				7/15/2016 2:58 PM
Terminations	Termination Reason	Insert				7/15/2016 2:58 PM