Covered Entity Details

DSH330196N CONEY ISLAND HOSPITAL (NYCHHC) (Terminated) - information as of 4/25/2025 9:21:15 PM

Main Details

Name

CONEY ISLAND HOSPITAL (NYCHHC)

Subdivision Name

MARINERS HARBOR FAMILY HEALTH CENTER - PEDIATRICS

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330196N

Medicare Provider Number

330196

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/16/2017

Participating Start Date

1/1/2018

Participating Approval Date

11/21/2017

Last Recertification Date

9/10/2018

Termination Date
Termination Reason

1/1/2019
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

New York City Health and Hospitals
Paul Albertson, Vice President
(212) 748-2256

Primary Contact

New York City Health + Hospitals
Danielle Sestito, Senior Director, 340B Operations
(212) 442-3892

Addresses

Street Address

2040 FOREST AVENUE
STATEN ISLAND, NY 10303

Billing Address

NEW YORK CITY HEALTH AND HOSPITALS/CONEY ISLAND
2601 Ocean Parkway
Brooklyn, NY 11235

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	330196

Shipping Addresses

Shipping Address 1

NEW YORK CITY HEALTH AND HOSPITALS/CONEY ISLAND
2601 Ocean Parkway
Brooklyn, NY 11235

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
DSH330196A	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	MARINERS HARBOR FAMILY HEALTH Center	2040 FOREST AVENUE	STATEN ISLAND	NY	Terminated
DSH330196B	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	STAPLETON Child Health Clinic	111 CANAL STREET	STATEN ISLAND	NY	Terminated
DSH330196C	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	HEALTH CONNECTION MOBILE MEDICAL OFFICE, C/O SEA VIEW HOSPITAL REHABILITATION CENTER AND HOME	460 BRIELLE AVENUE	STATEN ISLAND	NY	Terminated
DSH330196D	Child	DSH	CONEY ISLAND HOSPITAL	Mobile Medical Office Van #2 / Podiatry and Ophthalmology	460 Brielle Ave	Staten Island	NY	Terminated
DSH330196E	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel: Dental	2925 West 19th Street	Brooklyn	NY	Active
DSH330196F	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	Homecrest Health Center	1601 Ave S	Brooklyn	NY	Terminated
DSH330196G	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel: Chemical Dependency	2925 West 19th Street	Brooklyn	NY	Active
DSH330196H	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel: Primary Care Adults	2925 West 19th Street	Brooklyn	NY	Active
DSH330196J	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	IDA Israel: Pediatrics	2925 West 19th Street	Brooklyn	NY	Terminated
DSH330196K	Child	DSH	NYC Health + Hospitals/South Brooklyn Health	Ida Israel Clinic: Family Planning	2925 West 19th Street	Brooklyn	NY	Active
DSH330196L	Child	DSH	CONEY ISLAND HOSPITAL	Mobile Medical Office Van #4	2925 West 19th Street	Brooklyn	NY	Terminated
DSH330196M	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	STAPLETON Child Health Clinic - PEDIATRICS	111 Canal Street	STATEN ISLAND	NY	Terminated
DSH330196N	Child	DSH	CONEY ISLAND HOSPITAL (NYCHHC)	MARINERS HARBOR FAMILY HEALTH CENTER - PEDIATRICS	2040 FOREST AVENUE	STATEN ISLAND	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/31/2018 12:00:00 AM	12/3/2018 6:52 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/3/2018 6:52 AM
Terminations	Termination Date	Update	Termination Request		1/1/2019 12:00:00 AM	12/3/2018 6:52 AM
Terminations	Termination Effective Date	Update	Termination Request		10/31/2018 12:00:00 AM	12/3/2018 6:52 AM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	12/3/2018 6:52 AM
Details	Last Recertification Date	Update	Recertification		9/10/2018 1:18:40 AM	9/10/2018 1:18 AM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Albertson, Paul Vice President New York City Health and Hospitals 2127482256	11/21/2017 8:53 PM
Details	340B ID	Update	New Registration		DSH330196N	11/21/2017 8:53 PM
Details	Entity Subname	Update	New Registration	MARINERS HARBOR FAMILY HEALTH CENTER	MARINERS HARBOR FAMILY HEALTH CENTER - PEDIATRICS	11/21/2017 8:53 PM
Dates	Participating Approval Date	Update	New Registration		11/21/2017 8:53:16 PM	11/21/2017 8:53 PM
Details	State	Update	New Registration	Pending	Approved	11/21/2017 8:53 PM
Dates	Signed By Date	Update	New Registration		10/16/2017 12:00:14 PM	11/21/2017 8:53 PM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	11/21/2017 8:53 PM
Addresses	Main Address	Insert	New Registration		2040 FOREST AVENUE STATEN ISLAND, NY 10303	10/16/2017 10:16 AM
Addresses	Billing Address	Insert	New Registration		NEW YORK CITY HEALTH AND HOSPITALS/CONEY ISLAND 2601 Ocean Parkway Brooklyn, NY 11235	10/16/2017 10:16 AM
Addresses	Shipping Address	Insert	New Registration		NEW YORK CITY HEALTH AND HOSPITALS/CONEY ISLAND 2601 Ocean Parkway Brooklyn, NY 11235	10/16/2017 10:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 10:16 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		330196	10/16/2017 10:16 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	10/16/2017 10:16 AM
Contacts	Authorizing Official	Insert	New Registration		Albertson, Paul Vice President New York City Health and Hospitals 2127482256	10/16/2017 10:16 AM
Contacts	Primary Contact	Insert	New Registration		Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	10/16/2017 10:16 AM
Details	Last Recertification Date	Insert	New Registration			10/16/2017 10:16 AM
Details	Grant Number	Insert	New Registration			10/16/2017 10:16 AM
Details	340B ID	Insert	New Registration			10/16/2017 10:16 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/16/2017 10:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/16/2017 10:16 AM
Details	Medicare Provider Number	Insert	New Registration		330196	10/16/2017 10:16 AM
Details	Entity Name	Insert	New Registration		CONEY ISLAND HOSPITAL (NYCHHC)	10/16/2017 10:16 AM
Details	Program Code	Insert	New Registration		DSH	10/16/2017 10:16 AM
Details	Entity Subname	Insert	New Registration		MARINERS HARBOR FAMILY HEALTH CENTER	10/16/2017 10:16 AM
Dates	Participating Approval Date	Insert	New Registration			10/16/2017 10:16 AM
Details	State	Insert	New Registration		Pending	10/16/2017 10:16 AM
Dates	Registration Date	Insert	New Registration		10/16/2017 10:16:33 AM	10/16/2017 10:16 AM
Dates	Signed By Date	Insert	New Registration			10/16/2017 10:16 AM
Dates	Start Date	Insert	New Registration			10/16/2017 10:16 AM
Terminations	Termination Comments	Insert	New Registration			10/16/2017 10:16 AM
Terminations	Termination Date	Insert	New Registration			10/16/2017 10:16 AM
Terminations	Termination Effective Date	Insert	New Registration			10/16/2017 10:16 AM
Terminations	Termination Reason	Insert	New Registration			10/16/2017 10:16 AM