Covered Entity Details

DSH330238M NICHOLAS H. NOYES MEMORIAL HOSPITAL (Terminated) - information as of 4/30/2025 12:00:56 AM

Main Details

Name

NICHOLAS H. NOYES MEMORIAL HOSPITAL

Subdivision Name

Noyes Physician Clinic at Canaseraga

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330238M

Medicare Provider Number

330238

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/14/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/25/2017

Last Recertification Date

8/20/2020

Termination Date
Termination Reason

10/1/2021
Site closure

Contacts

Authorizing Official

Nicholas H. Noyes Memorial Hospital
Mark F Prunoske, SVP/CFO
(585) 335-4306

Primary Contact

UR Medicine
Katy Lees, Director, 340B Policy and Business Strategy
(585) 703-5169 Ext: 5855964002

Addresses

Street Address

12 North Church Street
Canaseraga, NY, NY 14822

Billing Address

Nicholas Noyes Hospital
111 Clara Barton Street
Dansville, NY 14437

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	3612351,00354476	1982625661,1861779449

Shipping Addresses

Shipping Address 1

Noyes Memorial Hospital
111 Clara Barton Street
Dansville, NY 14437

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
DSH330238A	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	NICHOLAS H NOYES MEMORIAL HOSPITAL / After Hours Urgent Care	50 E SOUTH ST	GENESEO	NY	Terminated
DSH330238B	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	NICHOLAS H NOYES MEMORIAL HOSPITAL / Outpatient Surgery	50 E SOUTH ST	GENESEO	NY	Terminated
DSH330238C	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Outpatient Kidney Disease and Dialysis Center	4616 Millenium Drive	Geneseo	NY	Terminated
DSH330238D	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Outpatient / Mental Health Service	1 MAIN ST	DANSVILLE	NY	Terminated
DSH330238E	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Outpatient Mental Health Service	9221 Robert Hart Drive	Dansville	NY	Terminated
DSH330238F	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Hospital Physician Clinics / Genesee Regional Orthopedics	111 Clara Barton Street	Dansville	NY	Terminated
DSH330238G	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Physician Clinic at Geneseo / Regional Orthopedics	50 E. South Street	Geneseo	NY	Terminated
DSH330238H	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Physician Clinic at Geneseo / Noyes Pain Management	50 E. South Street	Geneseo	NY	Terminated
DSH330238J	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Hospital Physician clinic / Noyes General Surgery Clinic	111 Clara Barton Street	Dansville	NY	Terminated
DSH330238K	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Hospital Physician Clinic / Noyes Pain Management	111 Clara Barton Street	Dansville	NY	Terminated
DSH330238L	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	NICHOLAS H NOYES MEMORIAL HOSPITAL / General Surgery Clinic at Geneseo	50 E SOUTH ST	GENESEO	NY	Terminated
DSH330238M	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes Physician Clinic at Canaseraga	12 North Church Street	Canaseraga, NY	NY	Terminated
DSH330238N	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	NICHOLAS H NOYES MEMORIAL HOSPITAL / Anesthesia Service	50 E SOUTH ST	GENESEO	NY	Terminated
DSH330238P	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	Noyes After Hours - Dansville / After Hours Care	Nicholas Noyes Hospital	Dansville	NY	Terminated
DSH330238Q	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	UR Medicine/Noyes Health Dialysis Center - UR Medicine/Noyes Health Dialysis Center	11 Murray Hill Drive	Mount Morris	NY	Terminated
DSH330238R	Child	DSH	NICHOLAS H. NOYES MEMORIAL HOSPITAL	NICHOLAS H NOYES MEMORIAL HOSPITAL - Primary Care	111 CLARA BARTON ST	DANSVILLE	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		12/31/2020 12:00:00 AM	9/2/2021 11:15 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/2/2021 11:15 AM
Terminations	Termination Date	Update	Recertification		10/1/2021 12:00:00 AM	9/2/2021 11:15 AM
Terminations	Termination Effective Date	Update	Recertification		1/1/2021 12:00:00 AM	9/2/2021 11:15 AM
Terminations	Termination Reason	Update	Recertification		Site closure	9/2/2021 11:15 AM
Contacts	Authorizing Official	Update	Profile Change Request	Prunoske, Mark F SVP/CFO Nicholas H. Noyes Memorial Hospital 5853354339	Prunoske, Mark F SVP/CFO Nicholas H. Noyes Memorial Hospital 5853354306	9/2/2021 7:18 AM
Contacts	Primary Contact	Update	Change Request	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857035169	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857035169-5855964002	12/10/2020 8:06 AM
Contacts	Authorizing Official	Update	Change Request	Maslyn, Jay CFO Nicholas Noyes Memorial Hospital 5853354306	Prunoske, Mark F SVP/CFO Nicholas H. Noyes Memorial Hospital 5853354339	9/7/2020 12:53 PM
Contacts	Primary Contact	Update	Profile Change Request	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857855154	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857035169	9/3/2020 12:10 PM
Contacts	Primary Contact	Update	Profile Change Request	Lees, Katy Associate Director of Pharmacy, 340B Policy and Business Strategy UR Medicine 5857855154	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857855154	8/21/2020 9:29 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1861779449 ( )		8/20/2020 3:48 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1982625661	8/20/2020 3:48 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/20/2020 3:48 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1861779449	8/20/2020 3:48 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/20/2020 3:48 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1982625661 ( )		8/20/2020 3:48 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 6:59:16 AM	8/20/2020 3:48:33 PM	8/20/2020 3:48 PM
Contacts	Primary Contact	Update	Profile Change Request	Lees, Katy 340B Business Manager UR Medicine 5857855154	Lees, Katy Associate Director of Pharmacy, 340B Policy and Business Strategy UR Medicine 5857855154	10/28/2019 11:14 AM
Addresses	Shipping Address	Insert	Recertification		Noyes Memorial Hospital 111 Clara Barton Street Dansville, NY 14437	9/5/2019 6:59 AM
Details	Last Recertification Date	Update	Recertification	9/6/2018 8:24:08 AM	9/5/2019 6:59:16 AM	9/5/2019 6:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/11/2019 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3612351	7/11/2019 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	7/11/2019 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1861779449	7/11/2019 2:57 PM
Details	Last Recertification Date	Update	Recertification	11/19/2017 9:00:16 AM	9/6/2018 8:24:08 AM	9/6/2018 8:24 AM
Contacts	Primary Contact	Insert	Recertification		Lees, Katy 340B Business Manager UR Medicine 5857855154	11/19/2017 9:00 AM
Details	Last Recertification Date	Update	Recertification		11/19/2017 9:00:16 AM	11/19/2017 9:00 AM
Contacts	Authorizing Official	Update		Maslyn, Jay CFO 5853354306	Maslyn, Jay CFO Nicholas Noyes Memorial Hospital 5853354306	10/23/2017 8:15 AM
Contacts	Signed By	Update		Maslyn, Jay CFO 5853354306	Maslyn, Jay CFO Nicholas Noyes Memorial Hospital 5853354306	10/23/2017 8:15 AM
Contacts	Authorizing Official	Insert			Maslyn, Jay CFO 5853354306	7/25/2017 12:45 PM
Contacts	Signed By	Insert			Maslyn, Jay CFO 5853354306	7/25/2017 12:45 PM
Addresses	Main Address	Insert			12 North Church Street Canaseraga, NY, NY 14822	7/25/2017 12:45 PM
Addresses	Billing Address	Insert			Nicholas Noyes Hospital 111 Clara Barton Street Dansville, NY 14437	7/25/2017 12:45 PM
Details	State	Update		Approved	Active	7/25/2017 12:45 PM
Dates	Participating Approval Date	Update			7/25/2017 12:00:00 AM	7/25/2017 12:45 PM
Details	State	Update		Pending	Approved	7/25/2017 12:45 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/25/2017 12:45 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_78574	DSH330238M	7/21/2017 9:55 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_78574	7/14/2017 10:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2017 10:12 AM
Medicaid Billing	Medicaid: Number	Insert			00354476	7/14/2017 10:12 AM
Medicaid Billing	Medicaid: State	Insert			NY	7/14/2017 10:12 AM
Medicaid Billing	NPI: Number	Insert			1982625661	7/14/2017 10:12 AM
Details	Last Recertification Date	Insert				7/14/2017 10:12 AM
Details	Grant Number	Insert				7/14/2017 10:12 AM
Details	340B ID	Insert				7/14/2017 10:12 AM
Details	Is Authorizing Official EHB Data	Insert				7/14/2017 10:12 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2017 10:12 AM
Details	Medicare Provider Number	Insert			330238	7/14/2017 10:12 AM
Details	Entity Name	Insert			NICHOLAS H. NOYES MEMORIAL HOSPITAL	7/14/2017 10:12 AM
Details	Program Code	Insert			DSH	7/14/2017 10:12 AM
Details	Entity Subname	Insert			Noyes Physician Clinic at Canaseraga	7/14/2017 10:12 AM
Dates	Participating Approval Date	Insert				7/14/2017 10:12 AM
Details	State	Insert			Pending	7/14/2017 10:12 AM
Dates	Registration Date	Insert			7/14/2017 12:00:00 AM	7/14/2017 10:12 AM
Dates	Signed By Date	Insert			7/14/2017 12:00:00 AM	7/14/2017 10:12 AM
Dates	Start Date	Insert				7/14/2017 10:12 AM
Terminations	Termination Comments	Insert				7/14/2017 10:12 AM
Terminations	Termination Date	Insert				7/14/2017 10:12 AM
Terminations	Termination Effective Date	Insert				7/14/2017 10:12 AM
Terminations	Termination Reason	Insert				7/14/2017 10:12 AM