Covered Entity Details

DSH330024AA THE MOUNT SINAI HOSPITAL (Active) - information as of 4/23/2025 10:54:15 PM

Main Details

Name

THE MOUNT SINAI HOSPITAL

Subdivision Name

Mount Sinai Hospital - Martin Luther King Jr HS

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330024AA

Medicare Provider Number

330024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/8/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/10/2019

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Mount Sinai
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149

Primary Contact

Mount Sinai Health System
Samuel Wilhelm-Ross, 340B Program Director
(646) 605-2006

Addresses

Street Address

122 Amsterdam Ave
New York, NY 10023

Billing Address

Mount Sinai Hospital
One Gustave L. Levy Place
New York, NY 10029

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	02998612,00243509	1932103413

Shipping Addresses

Shipping Address 1

Mount Sinai Hospital
101st between Madison & Fifth Ave
New York, NY 10029

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
DSH330024A	Child	DSH	THE MOUNT SINAI HOSPITAL		25-10 30TH AVENUE	LONG ISLAND CITY	NY	Active
DSH330024AA	Child	DSH	THE MOUNT SINAI HOSPITAL	Mount Sinai Hospital - Martin Luther King Jr HS	122 Amsterdam Ave	New York	NY	Active
DSH330024AB	Child	DSH	THE MOUNT SINAI HOSPITAL	Mount Sinai Hospital - Intermediate School 45	2351 First Avenue	New York	NY	Active
DSH330024AC	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Gastroenterology	3014 CRESCENT ST	ASTORIA	NY	Active
DSH330024AD	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Liver	3014 CRESCENT ST	ASTORIA	NY	Active
DSH330024AE	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Physical Therapy	3014 CRESCENT ST	ASTORIA	NY	Active
DSH330024AF	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Hematology Oncology	3014 CRESCENT ST	ASTORIA	NY	Active
DSH330024AG	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Rheumatology	3014 CRESCENT ST	ASTORIA	NY	Active
DSH330024AH	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Endocrinology	3014 CRESCENT ST	ASTORIA	NY	Active
DSH330024AJ	Child	DSH	THE MOUNT SINAI HOSPITAL	Mount Sinai Staten Island Cancer	1441 South Avenue	Staten Island	NY	Active
DSH330024AK	Child	DSH	THE MOUNT SINAI HOSPITAL	(MSQ CRESCENT) - Cardiology	3014 CRESCENT ST	ASTORIA	NY	Active
DSH330024AL	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Institute of Advanced Medicine	3014 CRESCENT ST	ASTORIA	NY	Approved
DSH330024AM	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI HOSPITAL (MSQ CRESCENT) - Express Care	3014 CRESCENT ST	ASTORIA	NY	Approved
DSH330024B	Child	DSH	THE MOUNT SINAI HOSPITAL	Primary Care Center	31-60 21st street	Astoria	NY	Active
DSH330024C	Child	DSH	THE MOUNT SINAI HOSPITAL	MOUNT SINAI QUEENS INFUSION	27-15 30th Avenue	Long Island City	NY	Terminated
DSH330024F	Child	DSH	THE MOUNT SINAI HOSPITAL	Manhattan Center for Math & Science	FDR Drive & E 116th Street	New York	NY	Active
DSH330024G	Child	DSH	THE MOUNT SINAI HOSPITAL	PS 83 Mendoza School	219 East 109th Street	New York	NY	Active
DSH330024H	Child	DSH	THE MOUNT SINAI HOSPITAL	Julia Richman High School	317 E. 67th Street	New York	NY	Active
DSH330024J	Child	DSH	THE MOUNT SINAI HOSPITAL	PS 38	232 East 103rd Street	New York	NY	Active
DSH330024K	Child	DSH	THE MOUNT SINAI HOSPITAL	JHS 117 (Alternative Education Complex)	240 East 109th Street	New York	NY	Active
DSH330024L	Child	DSH	THE MOUNT SINAI HOSPITAL	PS 108	1615 Madison Avenue	New York	NY	Active
DSH330024M	Child	DSH	THE MOUNT SINAI HOSPITAL	Bayard Rustin Education Complex (BREC)	West 18th Street	New York	NY	Active
DSH330024N	Child	DSH	THE MOUNT SINAI HOSPITAL	Joseph H. Hazan Amb. Cardiac Care Center	5 East 98th Street	New York	NY	Terminated
DSH330024P	Child	DSH	THE MOUNT SINAI HOSPITAL	Mt. Sinai Sports Therapy Center	625 Madison Avenue	New York	NY	Terminated
DSH330024Q	Child	DSH	THE MOUNT SINAI HOSPITAL	Mount Sinai Comprehensive Heath Program - Downtown	275 Seventh Avenue	New York	NY	Active
DSH330024R	Child	DSH	THE MOUNT SINAI HOSPITAL	Psychiatric Out-Patient Clinic	1160 Fifth Avenue	New York	NY	Active
DSH330024S	Child	DSH	THE MOUNT SINAI HOSPITAL	Mt. Sinai Adolescent Health Center	320 East 94th Street	New York	NY	Active
DSH330024T	Child	DSH	THE MOUNT SINAI HOSPITAL	Center of Advanced Medicine	5 East 102nd Street	New York	NY	Terminated
DSH330024U	Child	DSH	THE MOUNT SINAI HOSPITAL	Mount Sinai Kidney Center	520 East 117th Street	New York	NY	Active
DSH330024V	Child	DSH	THE MOUNT SINAI HOSPITAL	JACKSON HEIGHTS EXTENSION CLINIC	37-22 82nd Street	Jackson Heights	NY	Active
DSH330024W	Child	DSH	THE MOUNT SINAI HOSPITAL	Mount Sinai Queens - Emergency Department	25-10 30th Ave	Long Island City	NY	Active
DSH330024X	Child	DSH	THE MOUNT SINAI HOSPITAL	Mount Sinai Queens - Ambulatory Surgery	25-10 30th Ave	Long Island City	NY	Active
DSH330024Y	Child	DSH	THE MOUNT SINAI HOSPITAL	Louis Brandeis HS - Louis Brandeis HS	145 W 84th St	New York	NY	Active
DSH330024Z	Child	DSH	THE MOUNT SINAI HOSPITAL	A. Philip Randolph HS - A. Philip Randolph HS	443 W 135th St	New York	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 11:30:20 AM	8/12/2024 8:58:00 AM	8/12/2024 8:58 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 10:03:54 AM	8/14/2023 11:30:20 AM	8/14/2023 11:30 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 12:01:52 PM	8/26/2022 10:03:54 AM	8/26/2022 10:03 AM
Details	Last Recertification Date	Update	Recertification	9/4/2020 10:12:01 AM	8/16/2021 12:01:52 PM	8/16/2021 12:01 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/4/2020 10:12 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 12:30:40 PM	9/4/2020 10:12:01 AM	9/4/2020 10:12 AM
Details	Last Recertification Date	Update	Recertification		8/20/2019 12:30:40 PM	8/20/2019 12:30 PM
Contacts	Primary Contact	Update	Profile Change Request	Wilhelm-Ross, Samuel 340B Program Director Mount Sinai Health System 7182674352	Wilhelm-Ross, Samuel 340B Program Director Mount Sinai Health System 6466052006	5/14/2019 9:25 AM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Pastier, Michael Senior VP/CFO - The Mount Sinai Hospital Mount Sinai 2127313149	1/10/2019 7:15 AM
Details	340B ID	Update	New Registration		DSH330024AA	1/10/2019 7:15 AM
Details	Entity Name	Update	New Registration	MOUNT SINAI HOSPITAL	THE MOUNT SINAI HOSPITAL	1/10/2019 7:15 AM
Details	Entity Subname	Update	New Registration	Mount Sinai Hospital	Mount Sinai Hospital - Martin Luther King Jr HS	1/10/2019 7:15 AM
Dates	Participating Approval Date	Update	New Registration		1/10/2019 7:15:23 AM	1/10/2019 7:15 AM
Details	State	Update	New Registration	Pending	Approved	1/10/2019 7:15 AM
Dates	Signed By Date	Update	New Registration		1/8/2019 1:54:20 PM	1/10/2019 7:15 AM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	1/10/2019 7:15 AM
Addresses	Main Address	Insert	New Registration		122 Amsterdam Ave New York, NY 10023	1/8/2019 12:32 PM
Addresses	Billing Address	Insert	New Registration		Mount Sinai Hospital One Gustave L. Levy Place New York, NY 10029	1/8/2019 12:32 PM
Addresses	Shipping Address	Insert	New Registration		Mount Sinai Hospital 101st between Madison & Fifth Ave New York, NY 10029	1/8/2019 12:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/8/2019 12:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		02998612	1/8/2019 12:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/8/2019 12:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/8/2019 12:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00243509	1/8/2019 12:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/8/2019 12:32 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1932103413	1/8/2019 12:32 PM
Contacts	Authorizing Official	Insert	New Registration		Pastier, Michael Senior VP/CFO - The Mount Sinai Hospital Mount Sinai 2127313149	1/8/2019 12:32 PM
Contacts	Primary Contact	Insert	New Registration		Wilhelm-Ross, Samuel 340B Program Director Mount Sinai Health System 7182674352	1/8/2019 12:32 PM
Details	Last Recertification Date	Insert	New Registration			1/8/2019 12:32 PM
Details	Grant Number	Insert	New Registration			1/8/2019 12:32 PM
Details	340B ID	Insert	New Registration			1/8/2019 12:32 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/8/2019 12:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/8/2019 12:32 PM
Details	Medicare Provider Number	Insert	New Registration		330024	1/8/2019 12:32 PM
Details	Entity Name	Insert	New Registration		MOUNT SINAI HOSPITAL	1/8/2019 12:32 PM
Details	Program Code	Insert	New Registration		DSH	1/8/2019 12:32 PM
Details	Entity Subname	Insert	New Registration		Mount Sinai Hospital	1/8/2019 12:32 PM
Dates	Participating Approval Date	Insert	New Registration			1/8/2019 12:32 PM
Details	State	Insert	New Registration		Pending	1/8/2019 12:32 PM
Dates	Registration Date	Insert	New Registration		1/8/2019 12:32:32 PM	1/8/2019 12:32 PM
Dates	Signed By Date	Insert	New Registration			1/8/2019 12:32 PM
Dates	Start Date	Insert	New Registration			1/8/2019 12:32 PM
Terminations	Termination Comments	Insert	New Registration			1/8/2019 12:32 PM
Terminations	Termination Date	Insert	New Registration			1/8/2019 12:32 PM
Terminations	Termination Effective Date	Insert	New Registration			1/8/2019 12:32 PM
Terminations	Termination Reason	Insert	New Registration			1/8/2019 12:32 PM