Covered Entity Details

DSH330014P JAMAICA HOSPITAL MEDICAL CENTER (Active) - information as of 5/29/2025 1:59:02 AM

Main Details

Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

Jamaica Hospital Dental Clinic - Dental

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330014P

Medicare Provider Number

330014

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2018

Participating Start Date

1/1/2019

Participating Approval Date

10/25/2018

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

134-20 Jamaica Ave
jamaica, NY 11418

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	1225176175

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		01/12/2023	02/08/2023

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 11:55:02 AM	8/14/2024 9:51:33 AM	8/14/2024 9:51 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 10:41:04 AM	8/15/2023 11:55:02 AM	8/15/2023 11:55 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 3:35:19 PM	8/29/2022 10:41:04 AM	8/29/2022 10:41 AM
Details	Last Recertification Date	Update	Recertification	9/2/2020 3:46:06 PM	8/23/2021 3:35:19 PM	8/23/2021 3:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/2/2020 3:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		00243852	9/2/2020 3:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/2/2020 3:46 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/2/2020 3:46 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 3:44:21 PM	9/2/2020 3:46:06 PM	9/2/2020 3:46 PM
Details	Last Recertification Date	Update	Recertification		8/21/2019 3:44:21 PM	8/21/2019 3:44 PM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/25/2018 8:31 AM
Details	340B ID	Update	New Registration		DSH330014P	10/25/2018 8:31 AM
Details	Entity Subname	Update	New Registration	Jamaica Hospital Dental Clinic	Jamaica Hospital Dental Clinic - Dental	10/25/2018 8:31 AM
Dates	Participating Approval Date	Update	New Registration		10/25/2018 8:31:21 AM	10/25/2018 8:31 AM
Details	State	Update	New Registration	Pending	Approved	10/25/2018 8:31 AM
Dates	Signed By Date	Update	New Registration		10/12/2018 11:03:51 AM	10/25/2018 8:31 AM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	10/25/2018 8:31 AM
Addresses	Main Address	Insert	New Registration		134-20 Jamaica Ave jamaica, NY 11418	10/12/2018 11:03 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1225176175	10/12/2018 11:03 AM
Contacts	Authorizing Official	Insert	New Registration		DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/12/2018 11:03 AM
Contacts	Primary Contact	Insert	New Registration		Cosenza, Louis Director Jamaica Hospital Medical Center 7182066052	10/12/2018 11:03 AM
Details	Last Recertification Date	Insert	New Registration			10/12/2018 11:03 AM
Details	Grant Number	Insert	New Registration			10/12/2018 11:03 AM
Details	340B ID	Insert	New Registration			10/12/2018 11:03 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2018 11:03 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2018 11:03 AM
Details	Medicare Provider Number	Insert	New Registration		330014	10/12/2018 11:03 AM
Details	Entity Name	Insert	New Registration		JAMAICA HOSPITAL MEDICAL CENTER	10/12/2018 11:03 AM
Details	Program Code	Insert	New Registration		DSH	10/12/2018 11:03 AM
Details	Entity Subname	Insert	New Registration		Jamaica Hospital Dental Clinic	10/12/2018 11:03 AM
Dates	Participating Approval Date	Insert	New Registration			10/12/2018 11:03 AM
Details	State	Insert	New Registration		Pending	10/12/2018 11:03 AM
Dates	Registration Date	Insert	New Registration		10/12/2018 11:03:48 AM	10/12/2018 11:03 AM
Dates	Signed By Date	Insert	New Registration			10/12/2018 11:03 AM
Dates	Start Date	Insert	New Registration			10/12/2018 11:03 AM
Terminations	Termination Comments	Insert	New Registration			10/12/2018 11:03 AM
Terminations	Termination Date	Insert	New Registration			10/12/2018 11:03 AM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2018 11:03 AM
Terminations	Termination Reason	Insert	New Registration			10/12/2018 11:03 AM