Covered Entity Details

DSH100034D MOUNT SINAI MEDICAL CENTER (Active) - information as of 5/13/2025 11:01:50 PM

Main Details

Name

MOUNT SINAI MEDICAL CENTER

Subdivision Name

Mount Sinai Medical Center - Hialeah Emergency Dept.

Type

Disproportionate Share Hospital

Rural

340B ID

DSH100034D

Medicare Provider Number

100034

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/10/2019

Participating Start Date

10/1/2019

Participating Approval Date

7/22/2019

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Mount Sinai Medical Center
ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520

Primary Contact

Mount Sinai Medical Center
ANA CAROLINA CALDERA, DIRECTOR OF PHARMACY
(305) 674-2855

Addresses

Street Address

6050 W 20TH AVE
HIALEAH EMERGENCY DEPARTMENT
HIALEAH, FL 33016-2605

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
FL	010046300	1912964768

Shipping Addresses

Shipping Address 1

HIALEAH EMERGENCY DEPARTMENT
6050 W 20TH AVE
HIALEAH, FL 33016-2605

Shipping Address 2

MOUNT SINAI MEDICAL CENTER
4300 ALTON ROAD
MIAMI BEACH, FL 33140

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
DSH100034A	Child	DSH	MOUNT SINAI MEDICAL CENTER	COMPREHENSIVE CANCER CENTER	4306 ALTON ROAD	MIAMI BEACH	FL	Active
DSH100034B	Child	DSH	MOUNT SINAI MEDICAL CENTER	COMPREHENSIVE CANCER AT AVENTURA	2845 AVENTURA BLVD	AVENTURA	FL	Active
DSH100034C	Child	DSH	MOUNT SINAI MEDICAL CENTER	MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC.	2845 AVENTURA BLVD	AVENTURA	FL	Active
DSH100034D	Child	DSH	MOUNT SINAI MEDICAL CENTER	Mount Sinai Medical Center - Hialeah Emergency Dept.	6050 W 20TH AVE	HIALEAH	FL	Active
DSH100034E	Child	DSH	MOUNT SINAI MEDICAL CENTER	Mount Sinai Medical Center - Outpatient Behavioral Health Center	4302 Alton Road	Miami Beach	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 8:54:19 AM	9/3/2024 10:17:39 AM	9/3/2024 10:17 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 5:37:06 PM	9/5/2023 8:54:19 AM	9/5/2023 8:54 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	MOU003RN (AL)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	315772 (AZ)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1912964768 (CA)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	9000166797 (CO)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	822523928A (GA)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1912964768 (IA)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	590624424001 (IL)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1291087 (KY)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	43248200 (MN)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1912964768 (NC)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	350481 (OH)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	16118740001 (PA)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	10472B (SC)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	100034 (VT)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1912964768 (WI)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	350454 (NY)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	008002667 (CT)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	008014269 (CT)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	300031438 (IN)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1912964768 (ME)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	80036571 (NM)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	100507524 (NV)		9/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	071769601 (TX)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (AL)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (AZ)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (CA)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (CO)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (GA)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (IA)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (IL)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (KY)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (MN)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (NC)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (OH)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (PA)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (SC)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (VT)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (WI)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (NY)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (CT)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (IN)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (ME)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (NM)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (NV)		9/12/2022 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 (TX)		9/12/2022 5:37 PM
Details	Last Recertification Date	Update	Recertification	9/1/2021 8:07:15 AM	9/12/2022 5:37:06 PM	9/12/2022 5:37 PM
Addresses	Shipping Address	Insert	Recertification		HIALEAH EMERGENCY DEPARTMENT 6050 W 20TH AVE HIALEAH, FL 33016-2605	9/1/2021 8:07 AM
Addresses	Shipping Address	Insert	Recertification		MOUNT SINAI MEDICAL CENTER 4300 ALTON ROAD MIAMI BEACH, FL 33140	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		008002667	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		008014269	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		300031438	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IN	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1912964768	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ME	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		80036571	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NM	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100507524	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NV	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		071769601	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TX	9/1/2021 8:07 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/1/2021 8:07 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2021 8:07 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/1/2021 8:07 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2021 8:07 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/1/2021 8:07 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2021 8:07 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/1/2021 8:07 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2021 8:07 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/1/2021 8:07 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2021 8:07 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/1/2021 8:07 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2021 8:07 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 1:31:57 PM	9/1/2021 8:07:15 AM	9/1/2021 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		MOU003RN	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AL	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		315772	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		9000166797	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		822523928A	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IA	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		590624424001	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1291087	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		43248200	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MN	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		350481	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		16118740001	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		10472B	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100034	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		VT	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		350454	9/9/2020 1:31 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1912964768 ( )		9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/9/2020 1:31 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912964768	9/9/2020 1:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/9/2020 1:31 PM
Details	Last Recertification Date	Update	Recertification		9/9/2020 1:31:57 PM	9/9/2020 1:31 PM
Details	Entity Subname	Update	Recertification	MOUNT SINAI HOSPITAL OF GREATER MIA - Mount Sinai Medical Center - Hialeah Emergency Dept.	Mount Sinai Medical Center - Hialeah Emergency Dept.	9/9/2020 1:31 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		PALLIN, ANGEL SVP OF OPERATIONS Mount Sinai Medical Center 3056742520	7/22/2019 9:28 AM
Details	340B ID	Update	New Registration		DSH100034D	7/22/2019 9:28 AM
Details	Entity Name	Update	New Registration	MT. SINAI MEDICAL CENTER	MOUNT SINAI MEDICAL CENTER	7/22/2019 9:28 AM
Details	Entity Subname	Update	New Registration	MOUNT SINAI HOSPITAL OF GREATER MIA	MOUNT SINAI HOSPITAL OF GREATER MIA - Mount Sinai Medical Center - Hialeah Emergency Dept.	7/22/2019 9:28 AM
Dates	Participating Approval Date	Update	New Registration		7/22/2019 9:28:18 AM	7/22/2019 9:28 AM
Details	State	Update	New Registration	Pending	Approved	7/22/2019 9:28 AM
Dates	Signed By Date	Update	New Registration		7/15/2019 3:44:39 PM	7/22/2019 9:28 AM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	7/22/2019 9:28 AM
Addresses	Main Address	Insert	New Registration		6050 W 20TH AVE HIALEAH EMERGENCY DEPARTMENT HIALEAH, FL 33016-2605	7/10/2019 10:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/10/2019 10:48 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010046300	7/10/2019 10:48 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	7/10/2019 10:48 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1912964768	7/10/2019 10:48 AM
Contacts	Primary Contact	Insert	New Registration		CALDERA, ANA CAROLINA DIRECTOR OF PHARMACY Mount Sinai Medical Center 3056742855	7/10/2019 10:48 AM
Contacts	Authorizing Official	Insert	New Registration		PALLIN, ANGEL SVP OF OPERATIONS Mount Sinai Medical Center 3056742520	7/10/2019 10:48 AM
Details	Last Recertification Date	Insert	New Registration			7/10/2019 10:48 AM
Details	Grant Number	Insert	New Registration			7/10/2019 10:48 AM
Details	340B ID	Insert	New Registration			7/10/2019 10:48 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/10/2019 10:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/10/2019 10:48 AM
Details	Medicare Provider Number	Insert	New Registration		100034	7/10/2019 10:48 AM
Details	Entity Name	Insert	New Registration		MT. SINAI MEDICAL CENTER	7/10/2019 10:48 AM
Details	Program Code	Insert	New Registration		DSH	7/10/2019 10:48 AM
Details	Entity Subname	Insert	New Registration		MOUNT SINAI HOSPITAL OF GREATER MIA	7/10/2019 10:48 AM
Dates	Participating Approval Date	Insert	New Registration			7/10/2019 10:48 AM
Details	State	Insert	New Registration		Pending	7/10/2019 10:48 AM
Dates	Registration Date	Insert	New Registration		7/10/2019 10:48:06 AM	7/10/2019 10:48 AM
Dates	Signed By Date	Insert	New Registration			7/10/2019 10:48 AM
Dates	Start Date	Insert	New Registration			7/10/2019 10:48 AM
Terminations	Termination Comments	Insert	New Registration			7/10/2019 10:48 AM
Terminations	Termination Date	Insert	New Registration			7/10/2019 10:48 AM
Terminations	Termination Effective Date	Insert	New Registration			7/10/2019 10:48 AM
Terminations	Termination Reason	Insert	New Registration			7/10/2019 10:48 AM