Covered Entity Details

DSH080009B Bayhealth Hospital Sussex Campus (Active) - information as of 4/28/2025 4:00:36 AM

Main Details

Name

Bayhealth Hospital Sussex Campus

Subdivision Name

BAYHEALTH HOSPITAL SUSSEX CAMPUS - Milford Outpatient Imaging Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH080009B

Medicare Provider Number

080009

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/5/2018

Participating Start Date

3/15/2022

Participating Approval Date

5/10/2018

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Bayhealth Medical Center
Michael James Tretina, CFO
(302) 744-7162

Primary Contact

Bayhealth Medical Center
Alex Zarow, Pharmacy Director
(302) 744-6753

Addresses

Street Address

1020 MATTLIND WAY
MILFORD HOSPITAL OUTPATIENT IMAGING
MILFORD, DE 19963-1840

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?
No

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
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH080009A	Child	DSH	Bayhealth Hospital Sussex Campus	Bayhealth Hospital Sussex Campus - Cardiac Diagnostic Center	802 N DUPONT HWY	MILFORD	DE	Active
DSH080009B	Child	DSH	Bayhealth Hospital Sussex Campus	BAYHEALTH HOSPITAL SUSSEX CAMPUS - Milford Outpatient Imaging Center	1020 MATTLIND WAY	MILFORD	DE	Active
DSH080009C	Child	DSH	Bayhealth Hospital Sussex Campus	Bayhealth Hospital Susseex Campus - Milton Outpatient Center	632 MULBERRY ST	MILTON	DE	Active
DSH080009D	Child	DSH	Bayhealth Hospital Sussex Campus	BAYHEALTH MEDICAL CENTER INC - Harrington OP Services Center	16681 South Dupont Highway	HARRINGTON	DE	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 3:36:45 PM	8/22/2024 1:45:01 PM	8/22/2024 1:45 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 2:06:51 PM	8/21/2023 3:36:45 PM	8/21/2023 3:36 PM
Details	Last Recertification Date	Update	Recertification	9/2/2020 9:33:06 AM	9/1/2022 2:06:51 PM	9/1/2022 2:06 PM
Dates	Last Date That 340B Drugs Purchased	Update	COVID-19 Reinstatement	9/6/2021 12:00:00 AM		5/11/2022 6:51 PM
Details	State	Update	COVID-19 Reinstatement	Terminated	Active	5/11/2022 6:51 PM
Dates	Start Date	Update	COVID-19 Reinstatement	7/1/2018 12:00:00 AM	3/15/2022 12:00:00 AM	5/11/2022 6:51 PM
Terminations	Termination Comments	Update	COVID-19 Reinstatement	Pandemic Related		5/11/2022 6:51 PM
Terminations	Termination Date	Update	COVID-19 Reinstatement	10/1/2021 12:00:00 AM		5/11/2022 6:51 PM
Terminations	Termination Effective Date	Update	COVID-19 Reinstatement	1/19/2021 12:00:00 AM		5/11/2022 6:51 PM
Terminations	Termination Reason	Update	COVID-19 Reinstatement	DSH percentage below statutory minimum		5/11/2022 6:51 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/6/2021 12:00:00 AM	9/13/2021 9:51 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/13/2021 9:51 AM
Terminations	Termination Comments	Update	Recertification		Pandemic Related	9/13/2021 9:51 AM
Terminations	Termination Date	Update	Recertification		10/1/2021 12:00:00 AM	9/13/2021 9:51 AM
Terminations	Termination Effective Date	Update	Recertification		1/19/2021 12:00:00 AM	9/13/2021 9:51 AM
Terminations	Termination Reason	Update	Recertification		DSH percentage below statutory minimum	9/13/2021 9:51 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 9:20:54 AM	9/2/2020 9:33:06 AM	9/2/2020 9:33 AM
Contacts	Authorizing Official	Update	New Registration	Tretina, Michael CFO Bayhealth Medical Center 3027447162	Tretina, Michael James CFO Bayhealth Medical Center 3027447162	1/3/2020 10:13 AM
Contacts	Signed By	Update	New Registration	Tretina, Michael CFO Bayhealth Medical Center 3027447162	Tretina, Michael James CFO Bayhealth Medical Center 3027447162	1/3/2020 10:13 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 10:21:28 AM	8/26/2019 9:20:54 AM	8/26/2019 9:20 AM
Details	Entity Subname	Update	Recertification	BAYHEALTH MEDICAL CENTER INC - Milford Outpatient Imaging Center	BAYHEALTH HOSPITAL SUSSEX CAMPUS - Milford Outpatient Imaging Center	8/26/2019 9:20 AM
Details	Entity Name	Update	Change Request	MILFORD MEMORIAL HOSPITAL	Bayhealth Hospital Sussex Campus	1/29/2019 6:44 AM
Details	Last Recertification Date	Update	Recertification		8/21/2018 10:21:28 AM	8/21/2018 10:21 AM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Tretina, Michael CFO Bayhealth Medical Center 3027447162	5/10/2018 1:08 PM
Details	340B ID	Update	New Registration		DSH080009B	5/10/2018 1:08 PM
Details	Entity Subname	Update	New Registration	BAYHEALTH MEDICAL CENTER INC	BAYHEALTH MEDICAL CENTER INC - Milford Outpatient Imaging Center	5/10/2018 1:08 PM
Dates	Participating Approval Date	Update	New Registration		5/10/2018 1:08:47 PM	5/10/2018 1:08 PM
Details	State	Update	New Registration	Pending	Approved	5/10/2018 1:08 PM
Dates	Signed By Date	Update	New Registration		4/5/2018 3:10:57 PM	5/10/2018 1:08 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	5/10/2018 1:08 PM
Addresses	Main Address	Insert	New Registration		1020 MATTLIND WAY MILFORD HOSPITAL OUTPATIENT IMAGING MILFORD, DE 19963-1840	4/5/2018 3:10 PM
Contacts	Authorizing Official	Insert	New Registration		Tretina, Michael CFO Bayhealth Medical Center 3027447162	4/5/2018 3:10 PM
Contacts	Primary Contact	Insert	New Registration		Zarow, Alex Pharmacy Director Bayhealth Medical Center 3027446753	4/5/2018 3:10 PM
Details	Last Recertification Date	Insert	New Registration			4/5/2018 3:10 PM
Details	Grant Number	Insert	New Registration			4/5/2018 3:10 PM
Details	340B ID	Insert	New Registration			4/5/2018 3:10 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/5/2018 3:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/5/2018 3:10 PM
Details	Medicare Provider Number	Insert	New Registration		080009	4/5/2018 3:10 PM
Details	Entity Name	Insert	New Registration		MILFORD MEMORIAL HOSPITAL	4/5/2018 3:10 PM
Details	Program Code	Insert	New Registration		DSH	4/5/2018 3:10 PM
Details	Entity Subname	Insert	New Registration		BAYHEALTH MEDICAL CENTER INC	4/5/2018 3:10 PM
Dates	Participating Approval Date	Insert	New Registration			4/5/2018 3:10 PM
Details	State	Insert	New Registration		Pending	4/5/2018 3:10 PM
Dates	Registration Date	Insert	New Registration		4/5/2018 3:10:54 PM	4/5/2018 3:10 PM
Dates	Signed By Date	Insert	New Registration			4/5/2018 3:10 PM
Dates	Start Date	Insert	New Registration			4/5/2018 3:10 PM
Terminations	Termination Comments	Insert	New Registration			4/5/2018 3:10 PM
Terminations	Termination Date	Insert	New Registration			4/5/2018 3:10 PM
Terminations	Termination Effective Date	Insert	New Registration			4/5/2018 3:10 PM
Terminations	Termination Reason	Insert	New Registration			4/5/2018 3:10 PM