Covered Entity Details

DSH330096A JONES MEMORIAL HOSPITAL (Active) - information as of 6/26/2025 12:30:50 AM

Main Details

Name

JONES MEMORIAL HOSPITAL

Subdivision Name

Internal Medicine Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330096A

Medicare Provider Number

330096

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/14/2017

Participating Start Date

10/1/2017

Participating Approval Date

8/3/2017

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Jones Memorial Hospital
Boyd Chappell, Vice President of Finance / Chief Financial Officer
(585) 596-4002

Primary Contact

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

Addresses

Street Address

15 LODER ST
WELLSVILLE, NY 14895-1112

Billing Address

Jones Memorial Hospital
191 N Main Street
Wellsville, NY 14895

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	02389137,00354403	1508051913,1720030703,1376166538
PA	1007756480001	1508051913,1720030703

Shipping Addresses

Shipping Address 1

Jones Memorial Hospital
191 N Main Street
Wellsville, NY 14895

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
DSH330096A	Child	DSH	JONES MEMORIAL HOSPITAL	Internal Medicine Clinic	15 LODER ST	WELLSVILLE	NY	Active
DSH330096B	Child	DSH	JONES MEMORIAL HOSPITAL	Family Practice	191 N Main Street	Wellsville	NY	Active
DSH330096C	Child	DSH	JONES MEMORIAL HOSPITAL	Pediatrics	191 N Main Street	Wellsville	NY	Active
DSH330096D	Child	DSH	JONES MEMORIAL HOSPITAL	OB/GYN	191 N Main Street	Wellsville	NY	Active
DSH330096E	Child	DSH	JONES MEMORIAL HOSPITAL	Midwife	127 N MAIN ST	WELLSVILLE	NY	Terminated
DSH330096F	Child	DSH	JONES MEMORIAL HOSPITAL	Medical Practice - Belmont Office	5877 ROUTE 19	BELMONT	NY	Active
DSH330096G	Child	DSH	JONES MEMORIAL HOSPITAL	Family Practice	120 FIRST ST	BOLIVAR	NY	Active
DSH330096H	Child	DSH	JONES MEMORIAL HOSPITAL	OB/GYN	7309 Seneca Road North	HORNELL	NY	Active
DSH330096J	Child	DSH	JONES MEMORIAL HOSPITAL	Internal Medicine/Pulmonary	15 LODER ST	WELLSVILLE	NY	Active
DSH330096K	Child	DSH	JONES MEMORIAL HOSPITAL	OLEAN ONCOLOGY AND INFUSION - Oncology	1504 W State Street	Olean	NY	Active
DSH330096L	Child	DSH	JONES MEMORIAL HOSPITAL	THE MEMORIAL HOSPITAL OF WILLIAM F - Rheumatology Infusion and Clinic	7309 SENECA RD N	HORNELL	NY	Active
DSH330096M	Child	DSH	JONES MEMORIAL HOSPITAL	THE MEMORIAL HOSPITAL OF WILLIAM F - Rheumatology	1504 W STATE ST	OLEAN	NY	Active
DSH330096N	Child	DSH	JONES MEMORIAL HOSPITAL	Andover Primary Care - Andover Primary Care	13 S Main Street, Floor 1	Andover	NY	Active
DSH330096P	Child	DSH	JONES MEMORIAL HOSPITAL	HORNELL PRIMARY CARE - HRNL MV PRIMARY CARE-STE109	7309 SENECA RD N	HORNELL	NY	Active
DSH330096Q	Child	DSH	JONES MEMORIAL HOSPITAL	HORNELL PRIMARY CARE - HRNL MV PRIMARY CARE-STE101	7309 SENECA RD N	HORNELL	NY	Active
DSH330096R	Child	DSH	JONES MEMORIAL HOSPITAL	JONES MEMORIAL HOPSITAL - WLSVL 127NM PRIM CARE	127 N MAIN ST	WELLSVILLE	NY	Active
DSH330096S	Child	DSH	JONES MEMORIAL HOSPITAL	ALFRED GS PRIMARY CARE - ALFRED GS PRIMARY CARE	35 Glen Street	Alfred	NY	Active
DSH330096T	Child	DSH	JONES MEMORIAL HOSPITAL	JMH HORNELL SPECIALTY PRACTICES - HRNL MV NEUROLOGY (JMH)	7309 SENECA RD N	HORNELL	NY	Active
DSH330096U	Child	DSH	JONES MEMORIAL HOSPITAL	JMH OLEAN CLINIC/INFUSION - OLEAN WS RHEUMATOLOGY	1504 W STATE ST	OLEAN	NY	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 3:42:44 PM	8/23/2024 9:10:39 AM	8/23/2024 9:10 AM
Details	Last Recertification Date	Update	Recertification	8/28/2022 7:04:29 PM	8/21/2023 3:42:44 PM	8/21/2023 3:42 PM
Contacts	Authorizing Official	Update	Change Request	Helms, James Chief Executive Officer The Memorial Hospital of William F. and Gertrude F. Jones, Inc. 5855964002	Chappell, Boyd Vice President of Finance / Chief Financial Officer Jones Memorial Hospital 5855964002	10/4/2022 7:15 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 4:59:56 PM	8/28/2022 7:04:29 PM	8/28/2022 7:04 PM
Contacts	Authorizing Official	Update	Change Request	Howe, Jodi L VP of Finance Jones Memorial Hospital 6075964002	Helms, James Chief Executive Officer The Memorial Hospital of William F. and Gertrude F. Jones, Inc. 5855964002	5/17/2022 11:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/8/2021 4:59 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007756480001	9/8/2021 4:59 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/8/2021 4:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508051913	9/8/2021 4:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/8/2021 4:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1720030703	9/8/2021 4:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/8/2021 4:59 PM
Details	Last Recertification Date	Update	Recertification	8/20/2020 8:08:37 AM	9/8/2021 4:59:56 PM	9/8/2021 4:59 PM
Contacts	Authorizing Official	Update	Change Request	Helms, James Vice President of Finance/CFO The Memorial Hospital of William F. and Gertrude F. Jones, Inc. 5855964002	Howe, Jodi L VP of Finance Jones Memorial Hospital 6075964002	7/19/2021 7:40 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376166538	2/18/2021 9:16 PM
Medicaid Billing	NPI: State	Insert	Change Request		NY	2/18/2021 9:16 PM
Contacts	Authorizing Official	Update	Change Request	Helms, James Vice President of Finance Jones Memorial Hospital 5855964002	Helms, James Vice President of Finance/CFO The Memorial Hospital of William F. and Gertrude F. Jones, Inc. 5855964002	12/10/2020 9:59 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	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	Medicaid: Is Primary	Insert	Recertification		False	8/20/2020 8:08 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		02389137	8/20/2020 8:08 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	8/20/2020 8:08 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508051913	8/20/2020 8:08 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/20/2020 8:08 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1720030703	8/20/2020 8:08 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/20/2020 8:08 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1720030703 ( )		8/20/2020 8:08 AM
Details	Last Recertification Date	Update	Recertification	9/8/2019 9:48:44 AM	8/20/2020 8:08:37 AM	8/20/2020 8:08 AM
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	Billing Address	Insert	Change Request		Jones Memorial Hospital 191 N Main Street Wellsville, NY 14895	9/10/2019 9:33 AM
Addresses	Shipping Address	Insert	Change Request		Jones Memorial Hospital 191 N Main Street Wellsville, NY 14895	9/10/2019 9:33 AM
Addresses	Main Address	Update	Recertification	13 LODER ST WELLSVILLE, NY 14895-1112	15 LODER ST WELLSVILLE, NY 14895-1112	9/8/2019 9:48 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 12:10:41 PM	9/8/2019 9:48:44 AM	9/8/2019 9:48 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 7:14:44 AM	8/21/2018 12:10:41 PM	8/21/2018 12:10 PM
Details	Last Recertification Date	Update	Recertification		11/6/2017 7:14:44 AM	11/6/2017 7:14 AM
Contacts	Authorizing Official	Update		Helms, James Vice President of Finance 5855964002	Helms, James Vice President of Finance Jones Memorial Hospital 5855964002	10/2/2017 2:18 PM
Contacts	Signed By	Update		Helms, James Vice President of Finance 5855964002	Helms, James Vice President of Finance Jones Memorial Hospital 5855964002	10/2/2017 2:18 PM
Contacts	Primary Contact	Update		Lees, Katy 340B Business Manager 5857855154	Lees, Katy 340B Business Manager UR Medicine 5857855154	9/22/2017 3:08 PM
Contacts	Primary Contact	Insert			Lees, Katy 340B Business Manager 5857855154	8/30/2017 12:44 PM
Contacts	Authorizing Official	Insert			Helms, James Vice President of Finance 5855964002	8/10/2017 2:41 PM
Contacts	Signed By	Insert			Helms, James Vice President of Finance 5855964002	8/10/2017 2:41 PM
Addresses	Main Address	Insert			13 LODER ST WELLSVILLE, NY 14895-1112	8/3/2017 9:58 AM
Details	State	Update		Approved	Active	8/3/2017 9:58 AM
Dates	Participating Approval Date	Update			8/3/2017 12:00:00 AM	8/3/2017 9:56 AM
Details	State	Update		Pending	Approved	8/3/2017 9:56 AM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	8/3/2017 9:56 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_78578	DSH330096A	7/24/2017 9:51 AM
Details	Entity Subname	Update		JONES MEMORIAL HEALTHCARE	Internal Medicine Clinic	7/24/2017 9:51 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_78578	7/14/2017 10:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2017 10:18 AM
Medicaid Billing	Medicaid: Number	Insert			00354403	7/14/2017 10:18 AM
Medicaid Billing	Medicaid: State	Insert			NY	7/14/2017 10:18 AM
Medicaid Billing	NPI: Number	Insert			1720030703	7/14/2017 10:18 AM
Details	Last Recertification Date	Insert				7/14/2017 10:18 AM
Details	Grant Number	Insert				7/14/2017 10:18 AM
Details	340B ID	Insert				7/14/2017 10:18 AM
Details	Is Authorizing Official EHB Data	Insert				7/14/2017 10:18 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2017 10:18 AM
Details	Medicare Provider Number	Insert			330096	7/14/2017 10:18 AM
Details	Entity Name	Insert			JONES MEMORIAL HOSPITAL	7/14/2017 10:18 AM
Details	Program Code	Insert			DSH	7/14/2017 10:18 AM
Details	Entity Subname	Insert			JONES MEMORIAL HEALTHCARE	7/14/2017 10:18 AM
Dates	Participating Approval Date	Insert				7/14/2017 10:18 AM
Details	State	Insert			Pending	7/14/2017 10:18 AM
Dates	Registration Date	Insert			7/14/2017 12:00:00 AM	7/14/2017 10:18 AM
Dates	Signed By Date	Insert			7/14/2017 12:00:00 AM	7/14/2017 10:18 AM
Dates	Start Date	Insert				7/14/2017 10:18 AM
Terminations	Termination Comments	Insert				7/14/2017 10:18 AM
Terminations	Termination Date	Insert				7/14/2017 10:18 AM
Terminations	Termination Effective Date	Insert				7/14/2017 10:18 AM
Terminations	Termination Reason	Insert				7/14/2017 10:18 AM