Covered Entity Details

DSH330276AC NATHAN LITTAUER HOSPITAL (Active) - information as of 5/27/2025 11:38:03 PM

Main Details

Name

NATHAN LITTAUER HOSPITAL

Subdivision Name

Gloversville Primary Care Center - Surgery

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330276AC

Medicare Provider Number

330276

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/2/2019

Participating Start Date

1/1/2020

Participating Approval Date

10/9/2019

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Nathan Littauer Hospital
Michael Ostrander, Vice President-Finance & CFO
(518) 773-5480

Primary Contact

Nathan Littauer Hospital
Brenda Hammons, Pharmacy 340B Coordinator
(518) 773-5582

Addresses

Street Address

99 East State Street
Gloversville, NY 12078

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?
No

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
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330276A	Child	DSH	NATHAN LITTAUER HOSPITAL	Johnstown Primary/Specialty Care Center	110 Decker Drive Suite 100	Johnstown	NY	Active
DSH330276AA	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Urology	99 East State Street	Gloversville	NY	Active
DSH330276AB	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Neurology	99 East State Street	Gloversville	NY	Active
DSH330276AC	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Surgery	99 East State Street	Gloversville	NY	Active
DSH330276AD	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Women's Health	99 East State Street	Gloversville	NY	Active
DSH330276AE	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Anesthesia	99 East State Street	Gloversville	NY	Terminated
DSH330276AF	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Internal Medicine	99 East State Street	Gloversville	NY	Active
DSH330276AG	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Family Practice	99 East State Street	Gloversville	NY	Active
DSH330276AH	Child	DSH	NATHAN LITTAUER HOSPITAL	Broadalbin Primary/Specialty Care	103 COUNTY HIGHWAY 138	BROADALBIN	NY	Active
DSH330276AJ	Child	DSH	NATHAN LITTAUER HOSPITAL	Steele Avenue Primary Care Center - Otolaryngology	182 Steele Avenue	Gloversville	NY	Active
DSH330276AK	Child	DSH	NATHAN LITTAUER HOSPITAL	Amsterdam Primary/Urgent Care Center - Primary Care	375 Golf Course Road	Amsterdam	NY	Active
DSH330276AL	Child	DSH	NATHAN LITTAUER HOSPITAL	Amsterdam Primary/Urgent Care Center - Urgent Care	375 Golf Course Road	Amsterdam	NY	Active
DSH330276B	Child	DSH	NATHAN LITTAUER HOSPITAL	Mayfield Primary Care Center - Family Practice	2497 State Highway 30	Mayfield	NY	Active
DSH330276C	Child	DSH	NATHAN LITTAUER HOSPITAL	Mayfield Primary Care Center - Internal Medicine	2497 State Highway 30	Mayfield	NY	Active
DSH330276D	Child	DSH	NATHAN LITTAUER HOSPITAL	Mayfield Primary Care Center - Pediatrics	2497 State Highway 30	Mayfield	NY	Terminated
DSH330276E	Child	DSH	NATHAN LITTAUER HOSPITAL	Primary Care Center at Speculator - Internal Medicine	2862 State Highway 8	Speculator	NY	Active
DSH330276F	Child	DSH	NATHAN LITTAUER HOSPITAL	Caroga Lake Primary Care Center - Family Practice	1840 State Highway 10	Caroga Lake	NY	Active
DSH330276G	Child	DSH	NATHAN LITTAUER HOSPITAL	Steele Avenue Primary Care Center - Pediatrics	182 Steele Avenue	Gloversville	NY	Terminated
DSH330276H	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Internal Medicine	4104 State Highway 30	Perth	NY	Active
DSH330276J	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Family Practice	4104 State Highway 30	Perth	NY	Active
DSH330276K	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Pediatrics	4104 State Highway 30	Perth	NY	Active
DSH330276L	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Women's Health	4104 State Highway 30	Perth	NY	Active
DSH330276M	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Neurology	4104 State Highway 30	Perth	NY	Terminated
DSH330276N	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Podiatry	4104 State Highway 30	Perth	NY	Active
DSH330276P	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Radiology	4104 State Highway 30	Perth	NY	Terminated
DSH330276Q	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center - Occupational Medicine	4104 State Highway 30	Perth	NY	Active
DSH330276R	Child	DSH	NATHAN LITTAUER HOSPITAL	Primary/Specialty Care Center at Decker Drive - Pediatrics	110 Decker Drive	Johnstown	NY	Terminated
DSH330276S	Child	DSH	NATHAN LITTAUER HOSPITAL	FonClair Terrace Primary Care Center - Primary Care	2 FonClair Terrace	Johnstown	NY	Terminated
DSH330276T	Child	DSH	NATHAN LITTAUER HOSPITAL	Johnstown Surgery Center - Ambulatory Surgery	434 South Kingsboro Avenue Extension	Johnstown	NY	Active
DSH330276U	Child	DSH	NATHAN LITTAUER HOSPITAL	Perth-Broadalbin Primary Care Center / Gastroenterology	4104 State Highway 30	Perth	NY	Terminated
DSH330276V	Child	DSH	NATHAN LITTAUER HOSPITAL	Kingsboro GI Center/Gastroenterology	434 South Kingsboro Avenue Extension	Johnstown	NY	Active
DSH330276W	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center / Gastroenterology	99 East State Street	Gloversville	NY	Terminated
DSH330276X	Child	DSH	NATHAN LITTAUER HOSPITAL	Fonda Primary/Specialty Care Center - Family Practice	46 East Main Street	Fonda	NY	Active
DSH330276Y	Child	DSH	NATHAN LITTAUER HOSPITAL	Fonda Primary/Specialty Care Center - Internal Medicine	46 East Main Street	Fonda	NY	Active
DSH330276Z	Child	DSH	NATHAN LITTAUER HOSPITAL	Gloversville Primary Care Center - Pulmonology	99 East State Street	Gloversville	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 12:05:28 PM	8/19/2024 9:56:03 AM	8/19/2024 9:56 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 8:33:30 AM	8/17/2023 12:05:28 PM	8/17/2023 12:05 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 8:31:52 AM	8/29/2022 8:33:30 AM	8/29/2022 8:33 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 11:00:46 AM	8/24/2021 8:31:52 AM	8/24/2021 8:31 AM
Details	Last Recertification Date	Update	Recertification		9/3/2020 11:00:46 AM	9/3/2020 11:00 AM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Ostrander, Michael Vice President-Finance & CFO Nathan Littauer Hospital 5187735480	10/9/2019 8:14 AM
Details	340B ID	Update	New Registration		DSH330276AC	10/9/2019 8:14 AM
Details	Entity Name	Update	New Registration	NATHAN LITTAUER HOSPITAL & NURSING H	NATHAN LITTAUER HOSPITAL	10/9/2019 8:14 AM
Details	Entity Subname	Update	New Registration	Gloversville Primary Care Center	Gloversville Primary Care Center - Surgery	10/9/2019 8:14 AM
Dates	Participating Approval Date	Update	New Registration		10/9/2019 8:14:12 AM	10/9/2019 8:14 AM
Details	State	Update	New Registration	Pending	Approved	10/9/2019 8:14 AM
Dates	Signed By Date	Update	New Registration		10/7/2019 9:23:45 AM	10/9/2019 8:14 AM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	10/9/2019 8:14 AM
Addresses	Main Address	Insert	New Registration		99 East State Street Gloversville, NY 12078	10/2/2019 12:03 PM
Contacts	Authorizing Official	Insert	New Registration		Ostrander, Michael Vice President-Finance & CFO Nathan Littauer Hospital 5187735480	10/2/2019 12:03 PM
Contacts	Primary Contact	Insert	New Registration		Hammons, Brenda Pharmacy 340B Coordinator Nathan Littauer Hospital 5187735582	10/2/2019 12:03 PM
Details	Last Recertification Date	Insert	New Registration			10/2/2019 12:03 PM
Details	Grant Number	Insert	New Registration			10/2/2019 12:03 PM
Details	340B ID	Insert	New Registration			10/2/2019 12:03 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/2/2019 12:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/2/2019 12:03 PM
Details	Medicare Provider Number	Insert	New Registration		330276	10/2/2019 12:03 PM
Details	Entity Name	Insert	New Registration		NATHAN LITTAUER HOSPITAL & NURSING H	10/2/2019 12:03 PM
Details	Program Code	Insert	New Registration		DSH	10/2/2019 12:03 PM
Details	Entity Subname	Insert	New Registration		Gloversville Primary Care Center	10/2/2019 12:03 PM
Dates	Participating Approval Date	Insert	New Registration			10/2/2019 12:03 PM
Details	State	Insert	New Registration		Pending	10/2/2019 12:03 PM
Dates	Registration Date	Insert	New Registration		10/2/2019 12:03:42 PM	10/2/2019 12:03 PM
Dates	Signed By Date	Insert	New Registration			10/2/2019 12:03 PM
Dates	Start Date	Insert	New Registration			10/2/2019 12:03 PM
Terminations	Termination Comments	Insert	New Registration			10/2/2019 12:03 PM
Terminations	Termination Date	Insert	New Registration			10/2/2019 12:03 PM
Terminations	Termination Effective Date	Insert	New Registration			10/2/2019 12:03 PM
Terminations	Termination Reason	Insert	New Registration			10/2/2019 12:03 PM