Covered Entity Details

DSH330005AZ KALEIDA HEALTH (Active) - information as of 6/2/2025 8:28:31 AM

Main Details

Name

KALEIDA HEALTH

Subdivision Name

MAPLE WEST PLAZA / PODIATRY

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330005AZ

Medicare Provider Number

330005

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/5/2017

Participating Start Date

4/1/2017

Participating Approval Date

1/10/2017

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Kaleida Health
Chisholm P Hugh, EVP Chief Financial Officer
(716) 859-8836

Primary Contact

Kaleida Health
Wendy Ann DellaNeve, Manager 340B Program
(716) 859-8012

Addresses

Street Address

705 MAPLE ROAD
WILLIAMSVILLE, NY 14221

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	00384643	1053441907

Shipping Addresses

Shipping Address 1

MAPLE WEST PLAZA / PODIATRY
705 Maple Road
Amherst, NY 14221

Shipping Address 2

Kaleida Health
100 High Street
Buffalo, NY 14203

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
DSH330005A	Child	DSH	KALEIDA HEALTH	BUFFALO GENERAL HOSPITAL	100 HIGH STREET	BUFFALO	NY	Active
DSH330005AA	Child	DSH	KALEIDA HEALTH	Dental Clinic	1001 MAIN STREET	BUFFALO	NY	Terminated
DSH330005AB	Child	DSH	KALEIDA HEALTH	Plastic Surgery Clinic	1001 Main St	BUFFALO	NY	Active
DSH330005AC	Child	DSH	KALEIDA HEALTH	OCH Department of Otolaryngology (ENT)	1001 Main St	BUFFALO	NY	Active
DSH330005AD	Child	DSH	KALEIDA HEALTH	OCH - Orthopedics Center	1001 Main St	BUFFALO	NY	Active
DSH330005AE	Child	DSH	KALEIDA HEALTH	WOMEN & CHILDRENS HOSPITAL - Sports Medicine Clinic	219 BRYANT ST	BUFFALO	NY	Terminated
DSH330005AF	Child	DSH	KALEIDA HEALTH	OCH - Perinatal Clinic	1001 Main St	BUFFALO	NY	Active
DSH330005AG	Child	DSH	KALEIDA HEALTH	OCH - Rehabilitation Center	1001 Main St	BUFFALO	NY	Active
DSH330005AH	Child	DSH	KALEIDA HEALTH	DEGRAFF HOSPITAL - Geriatrics Clinic	445 TREMONT STREET	NORTH TONAWANDA	NY	Terminated
DSH330005AJ	Child	DSH	KALEIDA HEALTH	DEGRAFF HOSPITAL - Wound Care Clinic	445 TREMONT STREET	NORTH TONAWANDA	NY	Terminated
DSH330005AK	Child	DSH	KALEIDA HEALTH	DEGRAFF HOSPITAL - Disease Monitoring Clinic	445 TREMONT STREET	NORTH TONAWANDA	NY	Terminated
DSH330005AL	Child	DSH	KALEIDA HEALTH	DEGRAFF HOSPITAL - Women's Health Center	445 TREMONT STREET	NORTH TONAWANDA	NY	Terminated
DSH330005AM	Child	DSH	KALEIDA HEALTH	North Buffalo Medical Park Cardiology	900 HERTEL AVE	BUFFALO	NY	Active
DSH330005AN	Child	DSH	KALEIDA HEALTH	Hertel Elmwood Health Center Internal Medicine Clinic	900 HERTEL AVE	BUFFALO	NY	Active
DSH330005AP	Child	DSH	KALEIDA HEALTH	Hertel Elmwood Health Center Dermatology Clinic	900 HERTEL AVE	BUFFALO	NY	Terminated
DSH330005AQ	Child	DSH	KALEIDA HEALTH	Hertel Elmwood Health Center Podiatry Clinic	900 HERTEL AVE	BUFFALO	NY	Active
DSH330005AR	Child	DSH	KALEIDA HEALTH	Broadway Pediatrics -OCH Youth Link Clinic	1021 Broadway Street	Buffalo	NY	Active
DSH330005AS	Child	DSH	KALEIDA HEALTH	Behavioral Health Clinic - Main Street 1028	1028 Main Street	Buffalo	NY	Active
DSH330005AT	Child	DSH	KALEIDA HEALTH	NORTH BUFFALO SURGERY CLINIC	900 HERTEL AVE	BUFFALO	NY	Active
DSH330005AU	Child	DSH	KALEIDA HEALTH	CHILDREN'S HEALTHY WEIGHT OF BUFFALO	1001 Main St	BUFFALO	NY	Active
DSH330005AV	Child	DSH	KALEIDA HEALTH	VASCULAR ANOMALIES CLINIC	1001 Main St	BUFFALO	NY	Active
DSH330005AW	Child	DSH	KALEIDA HEALTH	MAPLE WEST PLAZA / PHYSICAL THERAPY	705 MAPLE ROAD	WILLIAMSVILLE	NY	Active
DSH330005AX	Child	DSH	KALEIDA HEALTH	MAPLE WEST PLAZA / SPEECH THERAPY	705 MAPLE ROAD	WILLIAMSVILLE	NY	Active
DSH330005AY	Child	DSH	KALEIDA HEALTH	MAPLE WEST PLAZA / OCCUPATIONAL THERAPY	705 MAPLE ROAD	WILLIAMSVILLE	NY	Active
DSH330005AZ	Child	DSH	KALEIDA HEALTH	MAPLE WEST PLAZA / PODIATRY	705 MAPLE ROAD	WILLIAMSVILLE	NY	Active
DSH330005B	Child	DSH	KALEIDA HEALTH	Kaleida Health DBA John R. Oishei Children's Hospital	818 Ellicott St.	BUFFALO	NY	Active
DSH330005BB	Child	DSH	KALEIDA HEALTH	OCH Fetal Care Center	1001 Main St.	BUFFALO	NY	Active
DSH330005BC	Child	DSH	KALEIDA HEALTH	KALEIDA HEALTH / DMH General Surgery Clinic	445 TREMONT ST	NORTH TONAWANDA	NY	Terminated
DSH330005BD	Child	DSH	KALEIDA HEALTH	KALEIDA HEALTH / DMH INFUSION CENTER	445 TREMONT ST	NORTH TONAWANDA	NY	Terminated
DSH330005BE	Child	DSH	KALEIDA HEALTH	OCH / INFUSION CENTER	818 Ellicott Street	BUFFALO	NY	Active
DSH330005BF	Child	DSH	KALEIDA HEALTH	Millard Fillmore Suburban at Spindrift Drive/ CHEMOTHERAPY CENTER	45 SPINDRIFT DRIVE	WILLIAMSVILLE	NY	Active
DSH330005BG	Child	DSH	KALEIDA HEALTH	Kaleida Health - Family Planning	1100 Main Street	Buffalo	NY	Active
DSH330005BH	Child	DSH	KALEIDA HEALTH	MILLARD FILLMORE SUBURBAN HOSPITAL - INFUSION THERAPY	1540 MAPLE ROAD	WILLIAMSVILLE	NY	Active
DSH330005BJ	Child	DSH	KALEIDA HEALTH	BUFFALO GENERAL HOSPITAL - BGH OP Transfusion	100 HIGH ST	BUFFALO	NY	Active
DSH330005BK	Child	DSH	KALEIDA HEALTH	BGMC Bariatric Clinic - Bariatric Clinic	100 High Street	Buffalo	NY	Approved
DSH330005BL	Child	DSH	KALEIDA HEALTH	BGMC Urology - Urology	100 High Street	Buffalo	NY	Approved
DSH330005D	Child	DSH	KALEIDA HEALTH	MILLARD FILLMORE SUBURBAN HOSPITAL	1540 MAPLE ROAD	WILLIAMSVILLE	NY	Active
DSH330005E	Child	DSH	KALEIDA HEALTH	DEGRAFF MEDICAL PARK	445 TREMONT STREET	NORTH TONAWANDA	NY	Active
DSH330005F	Child	DSH	KALEIDA HEALTH	North Buffalo Medical Park	900 Hertel Avenue	Buffalo	NY	Active
DSH330005G	Child	DSH	KALEIDA HEALTH	Broadway Pediatrics	1021 Broadway Street	Buffalo	NY	Active
DSH330005H	Child	DSH	KALEIDA HEALTH	Diabetes - Endocrinology Ctr. of WNY	705 Maple Road	Amherst	NY	Active
DSH330005J	Child	DSH	KALEIDA HEALTH	OCH Child Advocacy Program	556 Franklin Street	Buffalo	NY	Active
DSH330005K	Child	DSH	KALEIDA HEALTH	Niagara Street Pediatrics ( formerly Hodge Pediatrics)	1050 Niagara Street	Buffalo	NY	Active
DSH330005L	Child	DSH	KALEIDA HEALTH	Lockport OB/GYN	475 South Transit Road	Lockport	NY	Terminated
DSH330005M	Child	DSH	KALEIDA HEALTH	McKinley OB/GYN	3860 McKinley Parkway	Hamburg	NY	Terminated
DSH330005N	Child	DSH	KALEIDA HEALTH	Hamburg ENT	4535 Southwestern Blvd	Hamburg	NY	Active
DSH330005P	Child	DSH	KALEIDA HEALTH	Lancaster OB/GYN	6363 Transit Rd	Lancaster	NY	Terminated
DSH330005Q	Child	DSH	KALEIDA HEALTH	Kensington OB/GYN	462 Grider Street	Buffalo	NY	Active
DSH330005R	Child	DSH	KALEIDA HEALTH	Neurology Clinic	1001 MAIN STREET	BUFFALO	NY	Active
DSH330005S	Child	DSH	KALEIDA HEALTH	Surgery Clinic	1001 Main St	BUFFALO	NY	Active
DSH330005T	Child	DSH	KALEIDA HEALTH	Opthalmology Clinic	1001 MAIN STREET	BUFFALO	NY	Active
DSH330005U	Child	DSH	KALEIDA HEALTH	Lung Center Clinic	1001 Main St	BUFFALO	NY	Active
DSH330005V	Child	DSH	KALEIDA HEALTH	Rheumatology Clinic	1001 Main St	BUFFALO	NY	Active
DSH330005W	Child	DSH	KALEIDA HEALTH	Autism Disorder Center	1001 Main St	BUFFALO	NY	Active
DSH330005X	Child	DSH	KALEIDA HEALTH	Craniofacial Center	1001 MAIN STREET	BUFFALO	NY	Active
DSH330005Y	Child	DSH	KALEIDA HEALTH	Dermatology Clinic	1001 MAIN STREET	BUFFALO	NY	Active
DSH330005Z	Child	DSH	KALEIDA HEALTH	Niagara OBGYN (formerly Womens Health Clinic)	564 Niagara Street	BUFFALO	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/8/2023 3:36:01 AM	8/15/2024 2:43:49 PM	8/15/2024 2:43 PM
Contacts	Authorizing Official	Update	Change Request	Drake, Matthew D EVP Chief Financial Officer Kaleida Health 7168598836	Hugh, Chisholm P EVP Chief Financial Officer Kaleida Health 7168598836	10/26/2023 7:09 AM
Contacts	Primary Contact	Update	Profile Change Request	DellaNeve, Wendy Ann Supervisor 340B Program Kaleida Health 7168598012	DellaNeve, Wendy Ann Manager 340B Program Kaleida Health 7168598012	10/6/2023 12:46 PM
Addresses	Shipping Address	Insert	Recertification		MAPLE WEST PLAZA / PODIATRY 705 Maple Road Amherst, NY 14221	9/8/2023 3:36 AM
Addresses	Shipping Address	Insert	Recertification		Kaleida Health 100 High Street Buffalo, NY 14203	9/8/2023 3:36 AM
Details	Last Recertification Date	Update	Recertification	9/13/2022 1:48:24 PM	9/8/2023 3:36:01 AM	9/8/2023 3:36 AM
Details	Last Recertification Date	Update	Recertification	9/9/2021 8:38:27 AM	9/13/2022 1:48:24 PM	9/13/2022 1:48 PM
Contacts	Authorizing Official	Update	Change Request	Belter, Paul E EVP Chief Financial Officer Kaleida Health 7168598836	Drake, Matthew D EVP Chief Financial Officer Kaleida Health 7168598836	12/21/2021 3:57 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 9:46:54 AM	9/9/2021 8:38:27 AM	9/9/2021 8:38 AM
Contacts	Authorizing Official	Update	Change Request	Nesselbush, Robert Joseph EVP, CFO Kaleida Health 7168591215	Belter, Paul E EVP Chief Financial Officer Kaleida Health 7168598836	4/8/2021 10:37 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1053441907 ( )		9/11/2020 9:46 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1053441907	9/11/2020 9:46 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/11/2020 9:46 AM
Details	Last Recertification Date	Update	Recertification	9/20/2019 10:30:32 AM	9/11/2020 9:46:54 AM	9/11/2020 9:46 AM
Details	Last Recertification Date	Update	Recertification	8/30/2018 7:41:04 PM	9/20/2019 10:30:32 AM	9/20/2019 10:30 AM
Contacts	Primary Contact	Update	Profile Change Request	DellaNeve, Wendy Ann 340B Specialist Kaleida Health 7168598012	DellaNeve, Wendy Ann Supervisor 340B Program Kaleida Health 7168598012	6/12/2019 9:51 AM
Contacts	Primary Contact	Update	Change Request	Heiser, Amanda Accounting Manager Kaleida Health 7168598513	DellaNeve, Wendy Ann 340B Specialist Kaleida Health 7168598012	5/22/2019 7:02 AM
Contacts	Authorizing Official	Update	Change Request	Swiatkowski, Jonathan Thomas EVP, Chief Financial Officer Kaleida Health 7168598836	Nesselbush, Robert Joseph EVP, CFO Kaleida Health 7168591215	5/20/2019 9:05 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/7/2019 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00384643	3/7/2019 10:59 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	3/7/2019 10:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1053441907	3/7/2019 10:59 AM
Contacts	Primary Contact	Update	Change Request	Ryszka, Daniel 340B Coordinator Kaleida Health 7166902232	Heiser, Amanda Accounting Manager Kaleida Health 7168598513	10/22/2018 10:00 AM
Details	Last Recertification Date	Update	Recertification	11/14/2017 11:23:36 AM	8/30/2018 7:41:04 PM	8/30/2018 7:41 PM
Details	Last Recertification Date	Update	Recertification		11/14/2017 11:23:36 AM	11/14/2017 11:23 AM
Contacts	Primary Contact	Update		Ryszka, Daniel 340B Coordinator 7166902232	Ryszka, Daniel 340B Coordinator Kaleida Health 7166902232	10/19/2017 2:01 PM
Contacts	Authorizing Official	Update		Swiatkowski, Jonathan EVP, Chief Financial Officer 7168598836	Swiatkowski, Jonathan Thomas EVP, Chief Financial Officer Kaleida Health 7168598836	10/10/2017 5:49 PM
Contacts	Signed By	Update		Swiatkowski, Jonathan EVP, Chief Financial Officer 7168598836	Swiatkowski, Jonathan Thomas EVP, Chief Financial Officer Kaleida Health 7168598836	10/10/2017 5:49 PM
Contacts	Authorizing Official	Insert			Swiatkowski, Jonathan EVP, Chief Financial Officer 7168598836	7/17/2017 5:58 PM
Contacts	Signed By	Insert			Swiatkowski, Jonathan EVP, Chief Financial Officer 7168598836	7/17/2017 5:58 PM
Contacts	Primary Contact	Update		Heiser, Amanda Accounting Manager 7168598470	Ryszka, Daniel 340B Coordinator 7166902232	7/14/2017 3:22 PM
Addresses	Main Address	Insert			705 MAPLE ROAD WILLIAMSVILLE, NY 14221	7/14/2017 3:16 PM
Contacts	Primary Contact	Insert			Heiser, Amanda Accounting Manager 7168598470	7/13/2017 11:12 AM
Dates	Participating Approval Date	Update			1/10/2017 12:00:00 AM	1/10/2017 5:18 PM
Details	State	Update		Pending	Active	1/10/2017 5:18 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	1/10/2017 5:18 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_73795	DSH330005AZ	1/5/2017 11:11 AM
Details	Entity Subname	Update		MAPLE WEST PLAZA / MAPLE WEST PODIATRY	MAPLE WEST PLAZA / PODIATRY	1/5/2017 11:11 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_73795	1/5/2017 8:31 AM
Details	Last Recertification Date	Insert				1/5/2017 8:31 AM
Details	Grant Number	Insert				1/5/2017 8:31 AM
Details	340B ID	Insert				1/5/2017 8:31 AM
Details	Is Authorizing Official EHB Data	Insert				1/5/2017 8:31 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/5/2017 8:31 AM
Details	Medicare Provider Number	Insert			330005	1/5/2017 8:31 AM
Details	Entity Name	Insert			KALEIDA HEALTH	1/5/2017 8:31 AM
Details	Program Code	Insert			DSH	1/5/2017 8:31 AM
Details	Entity Subname	Insert			MAPLE WEST PLAZA / MAPLE WEST PODIATRY	1/5/2017 8:31 AM
Dates	Participating Approval Date	Insert				1/5/2017 8:31 AM
Details	State	Insert			Pending	1/5/2017 8:31 AM
Dates	Registration Date	Insert			1/5/2017 12:00:00 AM	1/5/2017 8:31 AM
Dates	Signed By Date	Insert			1/5/2017 12:00:00 AM	1/5/2017 8:31 AM
Dates	Start Date	Insert				1/5/2017 8:31 AM
Terminations	Termination Comments	Insert				1/5/2017 8:31 AM
Terminations	Termination Date	Insert				1/5/2017 8:31 AM
Terminations	Termination Effective Date	Insert				1/5/2017 8:31 AM
Terminations	Termination Reason	Insert				1/5/2017 8:31 AM