Covered Entity Details

DSH330014L JAMAICA HOSPITAL MEDICAL CENTER (Active) - information as of 6/6/2025 3:39:53 AM

Main Details

Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

JHMC-Extension Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330014L

Medicare Provider Number

330014

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2017

Participating Start Date

4/1/2017

Participating Approval Date

3/3/2017

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Jamaica Hospital
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Primary Contact

Jamaica Hospital Medical Center
Louis Cosenza, Director
(718) 206-6052

Addresses

Street Address

130-02 115th Avenue
South Ozone Park, NY 11420

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	00243852	1245370717

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
Contract Detail	AN-NOOR PHARMACY INC	35 101ST AVE		BROOKLYN	NY	11208	01/11/2019	04/01/2019			10/30/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330014A	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER	133-03 JAMAICA AVENUE	RICHMOND HILLS	NY	Active
DSH330014C	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOLLIS)	188-03 Jamaica Avenue	HOLLIS	NY	Active
DSH330014D	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOWARD BEACH)	156-10 CROSSBAY BLVD.	HOWARD BEACH	NY	Active
DSH330014E	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (JAMAICA)	149-18 JAMAICA AVENUE	JAMAICA	NY	Active
DSH330014F	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (RICHMOND HILL)	133-03 JAMAICA AVENUE	RICHMOND HILL	NY	Active
DSH330014G	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014H	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS SENIOR HEALTH CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014K	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	The Jamaica Hospital Mental Health Clinic	90-09 VanWyck Expressway	JAMAICA	NY	Active
DSH330014L	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	130-02 115th Avenue	South Ozone Park	NY	Active
DSH330014M	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	207-01 116TH AVENUE	CAMBRIA HEIGHTS	NY	Active
DSH330014N	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	125-20 SUTPHIN BLVD	JAMAICA	NY	Active
DSH330014P	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	Jamaica Hospital Dental Clinic - Dental	134-20 Jamaica Ave	jamaica	NY	Active
DSH330014Q	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	St.Albans - clinic	111-20 Merrick Blvd	St.Albans	NY	Active
DSH330014R	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	East New York - OP Clinic	3080 Atlantic Ave	Brooklyn	NY	Active
DSH330014S	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	HOLLIS TUDOR - CLINIC	200-16 HOLLIS AVE	SAINT ALBANS	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 3:50:25 PM	8/14/2024 9:47:52 AM	8/14/2024 9:47 AM
Contacts	Primary Contact	Update	Recertification	PANTALEO, NICHOLAS DIRECTOR OF PHARMACY Jamaica Hospital Medical Center 7182066090	Cosenza, Louis Director Jamaica Hospital Medical Center 7182066052	8/15/2023 3:50 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 10:39:31 AM	8/15/2023 3:50:25 PM	8/15/2023 3:50 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 3:33:30 PM	8/29/2022 10:39:31 AM	8/29/2022 10:39 AM
Details	Last Recertification Date	Update	Recertification	9/2/2020 4:04:45 PM	8/23/2021 3:33:30 PM	8/23/2021 3:33 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245370717	9/2/2020 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/2/2020 4:04 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1245370717 ( )		9/2/2020 4:04 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 3:32:11 PM	9/2/2020 4:04:45 PM	9/2/2020 4:04 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 3:26:48 PM	8/21/2019 3:32:11 PM	8/21/2019 3:32 PM
Details	Last Recertification Date	Update	Recertification	11/14/2017 10:00:40 AM	8/21/2018 3:26:48 PM	8/21/2018 3:26 PM
Details	Last Recertification Date	Update	Recertification	10/25/2017 3:19:55 PM	11/14/2017 10:00:40 AM	11/14/2017 10:00 AM
Details	Last Recertification Date	Update	Recertification		10/25/2017 3:19:55 PM	10/25/2017 3:19 PM
Contacts	Primary Contact	Update		PANTALEO, NICHOLAS DIRECTOR OF PHARMACY 7182066090	PANTALEO, NICHOLAS DIRECTOR OF PHARMACY Jamaica Hospital Medical Center 7182066090	10/3/2017 2:28 PM
Contacts	Authorizing Official	Update		DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/2/2017 2:49 PM
Contacts	Signed By	Update		DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/2/2017 2:49 PM
Contacts	Authorizing Official	Insert			DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	7/7/2017 3:56 PM
Contacts	Signed By	Insert			DOSS, MOUNIR F. EXECUTIVE VP & CFO 7182066291	7/7/2017 3:56 PM
Contacts	Primary Contact	Insert			PANTALEO, NICHOLAS DIRECTOR OF PHARMACY 7182066090	6/26/2017 6:24 PM
Addresses	Main Address	Insert			130-02 115th Avenue South Ozone Park, NY 11420	3/3/2017 4:45 PM
Dates	Participating Approval Date	Update			3/3/2017 12:00:00 AM	3/3/2017 4:43 PM
Details	State	Update		Pending	Active	3/3/2017 4:43 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	3/3/2017 4:43 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_74893	DSH330014L	2/16/2017 10:46 AM
Details	Entity Subname	Update		Jamaica Hospital Medical Center	JHMC-Extension Clinic	2/16/2017 10:46 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_74893	1/13/2017 3:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/13/2017 3:03 PM
Medicaid Billing	Medicaid: Number	Insert			00243852	1/13/2017 3:03 PM
Medicaid Billing	Medicaid: State	Insert			NY	1/13/2017 3:03 PM
Medicaid Billing	NPI: Number	Insert			1245370717	1/13/2017 3:03 PM
Details	Last Recertification Date	Insert				1/13/2017 3:03 PM
Details	Grant Number	Insert				1/13/2017 3:03 PM
Details	340B ID	Insert				1/13/2017 3:03 PM
Details	Is Authorizing Official EHB Data	Insert				1/13/2017 3:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2017 3:03 PM
Details	Medicare Provider Number	Insert			330014	1/13/2017 3:03 PM
Details	Entity Name	Insert			JAMAICA HOSPITAL MEDICAL CENTER	1/13/2017 3:03 PM
Details	Program Code	Insert			DSH	1/13/2017 3:03 PM
Details	Entity Subname	Insert			Jamaica Hospital Medical Center	1/13/2017 3:03 PM
Dates	Participating Approval Date	Insert				1/13/2017 3:03 PM
Details	State	Insert			Pending	1/13/2017 3:03 PM
Dates	Registration Date	Insert			1/13/2017 12:00:00 AM	1/13/2017 3:03 PM
Dates	Signed By Date	Insert			1/13/2017 12:00:00 AM	1/13/2017 3:03 PM
Dates	Start Date	Insert				1/13/2017 3:03 PM
Terminations	Termination Comments	Insert				1/13/2017 3:03 PM
Terminations	Termination Date	Insert				1/13/2017 3:03 PM
Terminations	Termination Effective Date	Insert				1/13/2017 3:03 PM
Terminations	Termination Reason	Insert				1/13/2017 3:03 PM