Covered Entity Details

DSH330090T ARNOT OGDEN MEDICAL CENTER (Active) - information as of 4/27/2025 12:48:41 AM

Main Details

Name

ARNOT OGDEN MEDICAL CENTER

Subdivision Name

Arnot-Ogden Medical Center - Arnot Health Wound Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330090T

Medicare Provider Number

330090

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/3/2019

Participating Start Date

10/1/2019

Participating Approval Date

8/15/2019

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Arnot Ogden Medical Center
Ronette Wiley, Senior Vice President and Chief Operating Officer
(607) 737-4486

Primary Contact

Arnot Ogden Medical Center
Rebecca Sue Carr-Reynolds, Interim Systems Director of Pharmacy
(607) 737-4283

Addresses

Street Address

602 Ivy Street
Elmira, NY 14905

Billing Address

Arnot Ogden Medical Center
600 Roe Avenue
Elmira, NY 14905

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	00363199	1083605661

Shipping Addresses

Shipping Address 1

Arnot Ogden Medical Center
600 Roe Avenue
Elmira, NY 14905

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
DSH330090A	Child	DSH	ARNOT OGDEN MEDICAL CENTER	IVY II DIALYSIS	602 IVY STREET	ELMIRA	NY	Terminated
DSH330090AA	Child	DSH	ARNOT OGDEN MEDICAL CENTER	AOMC Gastroenterology - Gastroenterology	555 St. Joseph's Boulevard	Elmira	NY	Active
DSH330090AB	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Horseheads Orthopedics - ARNOT OGDEN MEDICAL CENTER - orthopedic surgery	100 John Roemmelt Drive	Horseheads	NY	Active
DSH330090AC	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Horseheads Pediatrics - AOMC - Pediatric Medicine	100 John Roemmelt Drive	Horseheads	NY	Active
DSH330090AD	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Madison Orthopedic Surgery - AOMC - orthopedic surgery	200 Madison Ave	Elmira	NY	Active
DSH330090AE	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Eastside Walk In Care- AOMC - Walk In Care	200 Madison Ave, Suite 2C	Elmira	NY	Active
DSH330090AF	Child	DSH	ARNOT OGDEN MEDICAL CENTER	IMAST MultiSpecialty - AOMC - Multispecialty services	200 Madison Ave, 3rd Floor	Elmira	NY	Active
DSH330090AG	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Horseheads Orchard family Practice AOMC - Family Medicine	100 John Roemmelt Drive	Horseheads	NY	Active
DSH330090AH	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Bariatric/General Surgery AOMC - Surgery	1138 Broadway St	Elmira	NY	Active
DSH330090AJ	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Southport Internal Medicine AOMC - Internal Medicine	200 Madison Ave	Elmira	NY	Active
DSH330090AK	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Southside Family Practice AOMC - Family Medicine	1138 Broadway	Elmira	NY	Active
DSH330090AL	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Behavioral Services Unit (BSU) at SJH - Behavioral Health	571 Saint Josephs Blvd	Elmira	NY	Active
DSH330090B	Child	DSH	ARNOT OGDEN MEDICAL CENTER	CORNING DIALYSIS	8 PULTENEY STREET	CORNING	NY	Terminated
DSH330090D	Child	DSH	ARNOT OGDEN MEDICAL CENTER	HIV CLINIC	600 IVY STREET	ELMIRA	NY	Terminated
DSH330090E	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Schuyler Dialysis	220 Steuben Street	Montour Falls	NY	Terminated
DSH330090F	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT HEALTH PAIN MANAGEMENT	100 John Roemmelt Dr	Horseheads	NY	Active
DSH330090G	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Falck Cancer Center - Cancer Center	600 Roe Avenue	Elmira	NY	Terminated
DSH330090H	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - AOMC - HCFW Rheumatology	600 FITCH ST	ELMIRA	NY	Terminated
DSH330090J	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - AOMC - HSB Third floor Clinic	200 MADISON AVE	ELMIRA	NY	Terminated
DSH330090K	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - AOMC - HMOB 3rd floor clinic	100 JOHN ROEMMELT DR	HORSEHEADS	NY	Terminated
DSH330090L	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - AOMC - IVY II	602 IVY STREET	ELMIRA	NY	Active
DSH330090M	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - AOMC - Neurology	600 FITCH ST	ELMIRA	NY	ToBeTerminated
DSH330090N	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - AOMC Watkins Glen	104 S PORTER ST	WATKINS GLEN	NY	Active
DSH330090P	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - AOMC - Eastside Primary	200 MADISON AVE	ELMIRA	NY	Active
DSH330090Q	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot Ogden Medical Center - Arnot Health Wound Clinic	602 Ivy St	Elmira	NY	Terminated
DSH330090R	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot-Ogden Medical Center - Eastside Recovery Medicine AOMC	200 Madison Ave	Elmira	NY	Active
DSH330090S	Child	DSH	ARNOT OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER - Ithaca Ivy Clinic AOMC	521 W SENECA ST	ITHACA	NY	Active
DSH330090T	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot-Ogden Medical Center - Arnot Health Wound Clinic	602 Ivy Street	Elmira	NY	Active
DSH330090U	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot-Ogden Medical Center - Elmira Pediatrics AOMC	200 Madison Ave	Elmira	NY	Active
DSH330090V	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot-Ogden Medical Center - Horseheads Walk In Care AOMC	100 John Roemmelt Drive	Horseheads	NY	Active
DSH330090W	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot-Ogden Medical Center - Horseheads Internal Medicine AOMC	100 John Roemmelt Drive	Horseheads	NY	Active
DSH330090X	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot-Ogden Medical Center - Horseheads Cardiology AOMC	100 John Roemmelt Drive	Horseheads	NY	Active
DSH330090Y	Child	DSH	ARNOT OGDEN MEDICAL CENTER	Arnot-Ogden Medical Center - Horseheads Neurology AOMC	100 John Roemmelt Drive	Horseheads	NY	Active
DSH330090Z	Child	DSH	ARNOT OGDEN MEDICAL CENTER	AOMC Dermatology - Dermatology	200 Madison Ave Suite 1D	Elmira	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 6:01:01 PM	8/19/2024 9:54:10 AM	8/19/2024 9:54 AM
Contacts	Primary Contact	Update	Group Change Request	Carr-Reynolds, Rebecca Director of Pharmacy / PC Arnot Ogden Medical Center 6077374517	Carr-Reynolds, Rebecca Sue Interim Systems Director of Pharmacy Arnot Ogden Medical Center 6077374283	7/15/2024 7:07 AM
Contacts	Primary Contact	Update	Group Change Request	Dilmore, Nicole M System Director of Pharmacy ArnotHealth 6077374245	Carr-Reynolds, Rebecca Director of Pharmacy / PC Arnot Ogden Medical Center 6077374517	7/12/2024 7:43 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007558970013 (PA)		5/23/2024 4:50 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083605661 (PA)		5/23/2024 4:50 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 10:45:05 AM	8/23/2023 6:01:01 PM	8/23/2023 6:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/6/2022 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007558970013	10/6/2022 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	10/6/2022 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1083605661	10/6/2022 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	10/6/2022 10:36 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 4:24:17 PM	9/8/2022 10:45:05 AM	9/8/2022 10:45 AM
Contacts	Authorizing Official	Update	Change Request	Dworsky, Mark Vice President of Clinical Services Arnot Health 6077374152	Wiley, Ronette Senior Vice President and Chief Operating Officer Arnot Ogden Medical Center 6077374486	5/3/2022 7:38 AM
Details	Last Recertification Date	Update	Recertification	8/19/2020 11:39:02 AM	8/23/2021 4:24:17 PM	8/23/2021 4:24 PM
Contacts	Primary Contact	Update	Change Request	Bacon, Bill Director of Pharmacy Arnot Health 6077374311	Dilmore, Nicole M System Director of Pharmacy ArnotHealth 6077374245	1/29/2021 8:06 AM
Contacts	Authorizing Official	Update	Profile Change Request	Dworsky, Mark Service Line Admininistrator Arnot Health 6077371515	Dworsky, Mark Vice President of Clinical Services Arnot Health 6077374152	9/21/2020 11:10 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083605661 ( )		8/19/2020 11:39 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083605661	8/19/2020 11:39 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/19/2020 11:39 AM
Contacts	Primary Contact	Update	Recertification	Cleveland, Dwayne 340B Manager Arnot-Ogden Medical Center 6078731247	Bacon, Bill Director of Pharmacy Arnot Health 6077374311	8/19/2020 11:39 AM
Details	Last Recertification Date	Update	Recertification		8/19/2020 11:39:02 AM	8/19/2020 11:39 AM
Contacts	Authorizing Official	Update	Change Request	Dokken, Ron Vice President of Clinical Affairs Arnot Ogden Medical Center 6077374152	Dworsky, Mark Service Line Admininistrator Arnot Health 6077371515	3/5/2020 1:59 PM
Contacts	Primary Contact	Update	Change Request	BACON, BILL DIRECTOR OF PHARMACY Arnot Helath 6077374311	Cleveland, Dwayne 340B Manager Arnot-Ogden Medical Center 6078731247	1/9/2020 9:22 AM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Addresses	Billing Address	Insert	Change Request		Arnot Ogden Medical Center 600 Roe Avenue Elmira, NY 14905	9/10/2019 2:48 PM
Addresses	Shipping Address	Insert	Change Request		Arnot Ogden Medical Center 600 Roe Avenue Elmira, NY 14905	9/10/2019 2:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/10/2019 2:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00363199	9/10/2019 2:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	9/10/2019 2:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1083605661	9/10/2019 2:48 PM
Contacts	Signed By	Insert	New Registration		Lawrence, Jonathan President & CEO Arnot Health 6077374440	8/15/2019 7:56 AM
Details	340B ID	Update	New Registration		DSH330090T	8/15/2019 7:56 AM
Details	Entity Name	Update	New Registration	ARNOT-OGDEN MEDICAL CENTER	ARNOT OGDEN MEDICAL CENTER	8/15/2019 7:56 AM
Details	Entity Subname	Update	New Registration	Arnot-Ogden Medical Center	Arnot-Ogden Medical Center - Arnot Health Wound Clinic	8/15/2019 7:56 AM
Dates	Participating Approval Date	Update	New Registration		8/15/2019 7:56:43 AM	8/15/2019 7:56 AM
Details	State	Update	New Registration	Pending	Approved	8/15/2019 7:56 AM
Dates	Signed By Date	Update	New Registration		7/3/2019 11:42:35 AM	8/15/2019 7:56 AM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	8/15/2019 7:56 AM
Contacts	Authorizing Official	Update	Change Request	Lawrence, Jonathan President & CEO Arnot Health 6077374440	Dokken, Ron Vice President of Clinical Affairs Arnot Ogden Medical Center 6077374152	7/26/2019 3:02 PM
Addresses	Main Address	Insert	New Registration		602 Ivy Street Elmira, NY 14905	7/3/2019 10:11 AM
Contacts	Authorizing Official	Insert	New Registration		Lawrence, Jonathan President & CEO Arnot Health 6077374440	7/3/2019 10:11 AM
Contacts	Primary Contact	Insert	New Registration		BACON, BILL DIRECTOR OF PHARMACY Arnot Helath 6077374311	7/3/2019 10:11 AM
Details	Last Recertification Date	Insert	New Registration			7/3/2019 10:11 AM
Details	Grant Number	Insert	New Registration			7/3/2019 10:11 AM
Details	340B ID	Insert	New Registration			7/3/2019 10:11 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/3/2019 10:11 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/3/2019 10:11 AM
Details	Medicare Provider Number	Insert	New Registration		330090	7/3/2019 10:11 AM
Details	Entity Name	Insert	New Registration		ARNOT-OGDEN MEDICAL CENTER	7/3/2019 10:11 AM
Details	Program Code	Insert	New Registration		DSH	7/3/2019 10:11 AM
Details	Entity Subname	Insert	New Registration		Arnot-Ogden Medical Center	7/3/2019 10:11 AM
Dates	Participating Approval Date	Insert	New Registration			7/3/2019 10:11 AM
Details	State	Insert	New Registration		Pending	7/3/2019 10:11 AM
Dates	Registration Date	Insert	New Registration		7/3/2019 10:11:40 AM	7/3/2019 10:11 AM
Dates	Signed By Date	Insert	New Registration			7/3/2019 10:11 AM
Dates	Start Date	Insert	New Registration			7/3/2019 10:11 AM
Terminations	Termination Comments	Insert	New Registration			7/3/2019 10:11 AM
Terminations	Termination Date	Insert	New Registration			7/3/2019 10:11 AM
Terminations	Termination Effective Date	Insert	New Registration			7/3/2019 10:11 AM
Terminations	Termination Reason	Insert	New Registration			7/3/2019 10:11 AM