Covered Entity Details

DSH330234AL WESTCHESTER MEDICAL CENTER (Active) - information as of 6/14/2025 10:10:26 AM

Main Details

Name

WESTCHESTER MEDICAL CENTER

Subdivision Name

WMC Bradhurst: Ophthalmology Clinic SUITE 600

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330234AL

Medicare Provider Number

330234

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/14/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/31/2019

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Westchester Medical Center
Anthony Costello, COO
(914) 493-7028

Primary Contact

Westchester Medical Center
Varghese Thankachen, Network Director of Pharmacy Business Operations
(914) 493-7205

Addresses

Street Address

19 Bradhurst
Hawthorne, NY 10532

Billing Address

WESTCHESTER MEDICAL CENTER
100 WOODS ROAD
VALHALLA, NY 10595

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
NJ	4159608	1932280666
NY	00274213	1932280666
CT	003108992	1932280666

Shipping Addresses

Shipping Address 1

WESTCHESTER MEDICAL CENTER
100 WOODS ROAD
VALHALLA, NY 10595

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
DSH330234A	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Hematotherapy Clinic -Blood Storing, Processing & Transfusion	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234AA	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Turning Point	241 North Road	Poughkeepsie	NY	Terminated
DSH330234AB	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Recovery Room	241 North Road	Poughkeepsie	NY	Active
DSH330234AD	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Radiology	241 North Road	Poughkeepsie	NY	Active
DSH330234AE	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: RadioIsotopes	241 North Road	Poughkeepsie	NY	Terminated
DSH330234AF	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Respiratory Therapy	241 North Road	Poughkeepsie	NY	Active
DSH330234AG	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Ultrasound	241 North Road	Poughkeepsie	NY	Active
DSH330234AH	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Woundcare/Hyperbaric	1 Webster Avenue	Poughkeepsie	NY	Active
DSH330234AJ	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital - Observation Beds	241 North Road	Poughkeepsie	NY	Active
DSH330234AK	Child	DSH	WESTCHESTER MEDICAL CENTER	DENTISTRY CLINIC - MACY PAVILION	100 Woods Road	VALHALLA	NY	Terminated
DSH330234AL	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Ophthalmology Clinic SUITE 600	19 Bradhurst	Hawthorne	NY	Active
DSH330234AM	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Children's Clinic - Pediatric - Suite #550	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234AN	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Cancer Center - Outpatient Infusion Center	19 Bradhurst Avenue	Hawthorne	NY	Active
DSH330234AP	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC HEART AND VASCULAR IMAGING CENTER - RADIOLOGY - IMAGING	19 BRADHURST AVE	Hawthorne	NY	Terminated
DSH330234B	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Pulmonary Function Testing	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234C	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Adult Clinic - Suite #700	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234D	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: HIV-AIDS Ally Clinic - Suite #600	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234E	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Behavioral Health Center: Mental Health Clinic	20 HOSPITAL ROAD	Valhalla	NY	Active
DSH330234F	Child	DSH	WESTCHESTER MEDICAL CENTER	Referred Ambulatory Services	19 BRADHURST AVE	HAWTHORNE	NY	Terminated
DSH330234G	Child	DSH	WESTCHESTER MEDICAL CENTER	WMC Bradhurst: Advanced Imaging - Suite 1000	19 Bradhurst Ave.	Hawthorne	NY	Active
DSH330234H	Child	DSH	WESTCHESTER MEDICAL CENTER	Speech Pathology	19 Bradhurst Ave.	Hawthorne	NY	Terminated
DSH330234K	Child	DSH	Westchester Medical Center	MidHudson Regional Hospital: 6 Cooke	241 North Road	Poughkeepsie	NY	Terminated
DSH330234L	Child	DSH	Westchester Medical Center	MidHudson Regional Hospital: Alcohol Rehab	241 North Road	Poughkeepsie	NY	Terminated
DSH330234M	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Atrium Surgery Center	1 Webster Avenue	Poughkeepsie	NY	Active
DSH330234N	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Cardiac Cath Lab	241 North Road	Poughkeepsie	NY	Active
DSH330234P	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Diagnostic Cardiology	241 North Road	Poughkeepsie	NY	Active
DSH330234R	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Clinic	1 Webster Avenue	Poughkeepsie	NY	Terminated
DSH330234S	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: CT Scan	241 North Road	Poughkeepsie	NY	Active
DSH330234T	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Interventional Radiology	241 North Road	Poughkeepsie	NY	Active
DSH330234U	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: EEG	241 North Road	Poughkeepsie	NY	Active
DSH330234V	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Emergency Dept	241 North Road	Poughkeepsie	NY	Active
DSH330234W	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Wellness Center	241 North Road	Poughkeepsie	NY	Terminated
DSH330234Y	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Infusion Center	19 Baker Avenue	Poughkeepsie	NY	Active
DSH330234Z	Child	DSH	WESTCHESTER MEDICAL CENTER	MidHudson Regional Hospital: Operating Room	241 North Road	Poughkeepsie	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/1/2023 10:58:44 AM	9/5/2024 6:26:30 AM	9/5/2024 6:26 AM
Details	Entity Subname	Update	Recertification	WMC Bradhurst: Ophthalmology Clinic SUITE 3750S	WMC Bradhurst: Ophthalmology Clinic SUITE 600	9/5/2024 6:26 AM
Details	Last Recertification Date	Update	Recertification	9/13/2022 1:28:36 PM	9/1/2023 10:58:44 AM	9/1/2023 10:58 AM
Contacts	Primary Contact	Update	Profile Change Request	Thankachen, Varghese Director of Pharmacy Westchester Medical Center 9144937205	Thankachen, Varghese Network Director of Pharmacy Business Operations Westchester Medical Center 9144937205	7/13/2023 9:45 AM
Details	Last Recertification Date	Update	Recertification	9/14/2021 2:45:39 PM	9/13/2022 1:28:36 PM	9/13/2022 1:28 PM
Addresses	Main Address	Update	Recertification	20 HOSPITAL OVAL W. VALHALLA, NY 10595	19 Bradhurst Hawthorne, NY 10532	9/14/2021 2:45 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 4:00:26 PM	9/14/2021 2:45:39 PM	9/14/2021 2:45 PM
Details	Entity Subname	Update	Recertification	WMC Cedarwood Hall: Ophthalmology Clinic	WMC Bradhurst: Ophthalmology Clinic SUITE 3750S	9/14/2021 2:45 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	330234 (NY)		9/11/2020 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4159608	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		00274213	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003108992	9/11/2020 4:00 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/11/2020 4:00 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/11/2020 4:00 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/11/2020 4:00 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/11/2020 4:00 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/11/2020 4:00 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932280666	9/11/2020 4:00 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/11/2020 4:00 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1932280666 ( )		9/11/2020 4:00 PM
Details	Last Recertification Date	Update	Recertification	9/11/2019 4:28:32 PM	9/11/2020 4:00:26 PM	9/11/2020 4:00 PM
Details	Entity Subname	Update	Recertification	CEDARWOOD HALL OPHTHALMOLOGY CLINIC - OPHTHALMOLOGY	WMC Cedarwood Hall: Ophthalmology Clinic	9/11/2020 4:00 PM
Contacts	Authorizing Official	Update	Change Request	Esses, Allen Chief Supply Chain Officer Westchester Medical Center 9144936543	Costello, Anthony COO Westchester Medical Center 9144937028	3/6/2020 12:35 PM
Details	Last Recertification Date	Update	Recertification		9/11/2019 4:28:32 PM	9/11/2019 4:28 PM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Esses, Allen Chief Supply Chain Officer Westchester Medical Center 9144936543	1/31/2019 2:04 PM
Details	340B ID	Update	New Registration		DSH330234AL	1/31/2019 2:04 PM
Details	Entity Subname	Update	New Registration	CEDARWOOD HALL OPHTHALMOLOGY CLINIC	CEDARWOOD HALL OPHTHALMOLOGY CLINIC - OPHTHALMOLOGY	1/31/2019 2:04 PM
Dates	Participating Approval Date	Update	New Registration		1/31/2019 2:04:12 PM	1/31/2019 2:04 PM
Details	State	Update	New Registration	Pending	Approved	1/31/2019 2:04 PM
Dates	Signed By Date	Update	New Registration		1/14/2019 2:07:51 PM	1/31/2019 2:04 PM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	1/31/2019 2:04 PM
Addresses	Main Address	Insert	New Registration		20 HOSPITAL OVAL W. VALHALLA, NY 10595	1/14/2019 2:07 PM
Addresses	Billing Address	Insert	New Registration		WESTCHESTER MEDICAL CENTER 100 WOODS ROAD VALHALLA, NY 10595	1/14/2019 2:07 PM
Addresses	Shipping Address	Insert	New Registration		WESTCHESTER MEDICAL CENTER 100 WOODS ROAD VALHALLA, NY 10595	1/14/2019 2:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2019 2:07 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		330234	1/14/2019 2:07 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/14/2019 2:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1932280666	1/14/2019 2:07 PM
Contacts	Primary Contact	Insert	New Registration		Thankachen, Varghese Director of Pharmacy Westchester Medical Center 9144937205	1/14/2019 2:07 PM
Contacts	Authorizing Official	Insert	New Registration		Esses, Allen Chief Supply Chain Officer Westchester Medical Center 9144936543	1/14/2019 2:07 PM
Details	Last Recertification Date	Insert	New Registration			1/14/2019 2:07 PM
Details	Grant Number	Insert	New Registration			1/14/2019 2:07 PM
Details	340B ID	Insert	New Registration			1/14/2019 2:07 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2019 2:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2019 2:07 PM
Details	Medicare Provider Number	Insert	New Registration		330234	1/14/2019 2:07 PM
Details	Entity Name	Insert	New Registration		WESTCHESTER MEDICAL CENTER	1/14/2019 2:07 PM
Details	Program Code	Insert	New Registration		DSH	1/14/2019 2:07 PM
Details	Entity Subname	Insert	New Registration		CEDARWOOD HALL OPHTHALMOLOGY CLINIC	1/14/2019 2:07 PM
Dates	Participating Approval Date	Insert	New Registration			1/14/2019 2:07 PM
Details	State	Insert	New Registration		Pending	1/14/2019 2:07 PM
Dates	Registration Date	Insert	New Registration		1/14/2019 2:07:47 PM	1/14/2019 2:07 PM
Dates	Signed By Date	Insert	New Registration			1/14/2019 2:07 PM
Dates	Start Date	Insert	New Registration			1/14/2019 2:07 PM
Terminations	Termination Comments	Insert	New Registration			1/14/2019 2:07 PM
Terminations	Termination Date	Insert	New Registration			1/14/2019 2:07 PM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2019 2:07 PM
Terminations	Termination Reason	Insert	New Registration			1/14/2019 2:07 PM