Covered Entity Details

DSH330013L ALBANY MEDICAL CENTER HOSPITAL (Active) - information as of 4/24/2025 11:12:40 PM

Main Details

Name

ALBANY MEDICAL CENTER HOSPITAL

Subdivision Name

AMCH HIV Medicine Clinic - HIV Medicine

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330013L

Medicare Provider Number

330013

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/4/2019

Participating Start Date

1/1/2020

Participating Approval Date

10/25/2019

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Albany Medical Center Hospital
Frances Spreer Albert, Executive Vice President, COO and CFO
(518) 262-3579

Primary Contact

Albany Med Health System
Alan W Slowick, System Associate Director of Pharmacy - 340B
(518) 926-2527

Addresses

Street Address

1 Clara Barton Drive
Albany, NY 12208

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
NY	330013	1376577247

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
Contract Detail	ALBANY MEDICAL CENTER HOSPITAL	PHARMACY DEPARTMENT	43 NEW SCOTLAND AVE	ALBANY	NY	12208-3412	10/25/2019	01/01/2020			03/30/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330013AA	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Gastroenterology Clinic - Pediatric Gastroenterology	22 New Scotland Ave	Albany	NY	Active
DSH330013AB	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Surgery - Pediatric Surgery	50 New Scotland Ave	Albany	NY	Active
DSH330013AC	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Endocrinology Clinic - Pediatric Endocrinology	22 New Scotland Ave	Albany	NY	Active
DSH330013AD	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Behavioral Health Clinic - Ped Behavioral Health	391 Myrtle Ave	Albany	NY	Active
DSH330013AE	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	ALLERGY & IMMUNOLOGY CLINIC OF AMCH - ALLERGY & IMMUNOLOGY	176 WASHINGTON AVENUE EXTENSION	ALBANY	NY	Active
DSH330013AF	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Neurology clinic - Pediatric Neurology	391 Myrtle Ave	Albany	NY	Active
DSH330013AG	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH General Pediatrics - Pediatrics	391 Myrtle Ave	Albany	NY	Active
DSH330013AH	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Neurosurgery Spine and Pain Center - NS spine, pain, PM&R	391 Myrtle Ave	Albany	NY	Active
DSH330013AJ	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH OB/GYN clinic - obstetrics and Gynecology	391 Myrtle Ave	Albany	NY	Active
DSH330013AK	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	INTERNAL MEDICINE CLINIC OF AMCH - Internal Medicine	178 WASHINGTON AVENUE EXT	ALBANY	NY	Active
DSH330013AL	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	Community Endocrinology Clinic - Endocrinology	220 Washington Ave Ext	Albany	NY	Active
DSH330013AM	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	Clifton Park Neurology Clinic - Neurology	989 Route 146	Clifton Park	NY	Active
DSH330013AN	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	Clifton Park Multispecialty Clinic - Multiple	453 NY-Rt 146	Clifton Park	NY	Active
DSH330013AP	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Podiatry - Podiatry	220 Washington Ave Ext	Albany	NY	Active
DSH330013AQ	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Ophthalmology - Ophthalmology	391 Myrtle Ave	Albany	NY	Active
DSH330013B	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	SCC OUTPATIENT SURGERY AND RELATED SERVICES	25 HACKETT BLVD	ALBANY	NY	Active
DSH330013C	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	SCC OUTPATIENT RADIOLOGY AND RELATED SERVICES	25 HACKETT BLVD	ALBANY	NY	Active
DSH330013D	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	SCC OUTPATIENT OBSERVATION AND RELATED SERVICES	25 HACKETT BLVD	ALBANY	NY	Active
DSH330013E	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Endocrinology Clinic - Endocrinology	25 Hackett Blvd	Albany	NY	Active
DSH330013F	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Urology Clinic - Urology	23 Hackett Blvd	Albany	NY	Active
DSH330013G	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Nephrology Clinic - Nephrology	25 Hackett Blvd	Albany	NY	Active
DSH330013H	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Breast Center and Surgery Clinic - Surgery	25 Hackett Blvd	Albany	NY	Active
DSH330013J	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Student Health Center Clinic - Student Health	25 hackett Blvd	albany	NY	Active
DSH330013K	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Infectious Disease Clinic - Infectious Disease	25 Hackett Blvd	albany	NY	Active
DSH330013L	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH HIV Medicine Clinic - HIV Medicine	1 Clara Barton Drive	Albany	NY	Active
DSH330013M	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Bariatric Surgery Clinic - Bariatric Surgery	99 Delaware Ave	Delmar	NY	Active
DSH330013N	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Rheumatology Clinic - Pediatric Rheumatology	22 New Scotland Ave	Albany	NY	Active
DSH330013P	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Rheumatology Clinic - Rheumatology	99 Delaware Ave	Delmar	NY	Active
DSH330013Q	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Infectious Disease Clinic - Pediatric Infectious Disease	22 New Scotland Ave	Albany	NY	Active
DSH330013R	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pulmonary Clinic - Pulmonary	16 New Scotland Ave	Albany	NY	Active
DSH330013S	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Cardiothoracic Clinic - Cardiothoracic Surgery	50 New Scotland Ave	Albany	NY	Active
DSH330013T	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Plastic and Cosmetic Surgery Clinic - Plastic and Cosmetic Surgery	50 New Scotland Ave	Albany	NY	Active
DSH330013U	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Latham Medicine and Pediatrics Clinic - Medicine and Pediatrics	1019 New Loudon Rd	Latham	NY	Active
DSH330013V	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Otolaryngology Clinic - Otolaryngology (Incl Ped)	50 New Scotland Ave	Albany	NY	Active
DSH330013W	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Nephrology Clinic - Pediatric Nephrology	22 New Scotland Ave	Albany	NY	Active
DSH330013X	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Pumonary Clinic - Pediatric Pulmonary	22 New Scotland Ave	Albany	NY	Active
DSH330013Y	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH Pediatric Genetics Clinic - Pediatrics Genetics	22 New Scotland Ave	Albany	NY	Active
DSH330013Z	Child	DSH	ALBANY MEDICAL CENTER HOSPITAL	AMCH General Surgery - Surgery	50 New Scotland Ave	Albany	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	dispirito, anthony Director Pharmacy Services Albany Medical Center Hospital 5182623255	Slowick, Alan W System Associate Director of Pharmacy - 340B Albany Med Health System 5189262527	10/11/2024 8:04 AM
Details	Last Recertification Date	Update	Recertification	8/18/2023 11:32:35 AM	9/3/2024 2:18:21 PM	9/3/2024 2:18 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 12:22:17 PM	8/18/2023 11:32:35 AM	8/18/2023 11:32 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 10:31:03 AM	9/12/2022 12:22:17 PM	9/12/2022 12:22 PM
Contacts	Authorizing Official	Update	Change Request	VENDITTI, FERDINAND J. EXECUTIVE VP FOR SYSTEM CARE DELIVERY Albany Medical Center Hospital 5182625376	Albert, Frances Spreer Executive Vice President, COO and CFO Albany Medical Center Hospital 5182623579	3/25/2022 12:15 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 3:51:01 PM	8/17/2021 10:31:03 AM	8/17/2021 10:31 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1376577247 ( )		8/18/2020 3:51 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1376577247	8/18/2020 3:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/18/2020 3:51 PM
Details	Last Recertification Date	Update	Recertification		8/18/2020 3:51:01 PM	8/18/2020 3:51 PM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		VENDITTI, FERDINAND J. EXECUTIVE VP FOR SYSTEM CARE DELIVERY Albany Medical Center Hospital 5182625376	10/25/2019 12:39 PM
Details	340B ID	Update	New Registration		DSH330013L	10/25/2019 12:39 PM
Details	Entity Subname	Update	New Registration	AMCH HIV Medicine Clinic	AMCH HIV Medicine Clinic - HIV Medicine	10/25/2019 12:39 PM
Dates	Participating Approval Date	Update	New Registration		10/25/2019 12:39:30 PM	10/25/2019 12:39 PM
Details	State	Update	New Registration	Pending	Approved	10/25/2019 12:39 PM
Dates	Signed By Date	Update	New Registration		10/8/2019 1:10:35 PM	10/25/2019 12:39 PM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	10/25/2019 12:39 PM
Addresses	Main Address	Insert	New Registration		1 Clara Barton Drive Albany, NY 12208	10/4/2019 3:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/4/2019 3:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		330013	10/4/2019 3:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	10/4/2019 3:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376577247	10/4/2019 3:59 PM
Contacts	Authorizing Official	Insert	New Registration		VENDITTI, FERDINAND J. EXECUTIVE VP FOR SYSTEM CARE DELIVERY Albany Medical Center Hospital 5182625376	10/4/2019 3:59 PM
Contacts	Primary Contact	Insert	New Registration		dispirito, anthony Director Pharmacy Services Albany Medical Center Hospital 5182623255	10/4/2019 3:59 PM
Details	Last Recertification Date	Insert	New Registration			10/4/2019 3:59 PM
Details	Grant Number	Insert	New Registration			10/4/2019 3:59 PM
Details	340B ID	Insert	New Registration			10/4/2019 3:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/4/2019 3:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/4/2019 3:59 PM
Details	Medicare Provider Number	Insert	New Registration		330013	10/4/2019 3:59 PM
Details	Entity Name	Insert	New Registration		ALBANY MEDICAL CENTER HOSPITAL	10/4/2019 3:59 PM
Details	Program Code	Insert	New Registration		DSH	10/4/2019 3:59 PM
Details	Entity Subname	Insert	New Registration		AMCH HIV Medicine Clinic	10/4/2019 3:59 PM
Dates	Participating Approval Date	Insert	New Registration			10/4/2019 3:59 PM
Details	State	Insert	New Registration		Pending	10/4/2019 3:59 PM
Dates	Registration Date	Insert	New Registration		10/4/2019 3:59:49 PM	10/4/2019 3:59 PM
Dates	Signed By Date	Insert	New Registration			10/4/2019 3:59 PM
Dates	Start Date	Insert	New Registration			10/4/2019 3:59 PM
Terminations	Termination Comments	Insert	New Registration			10/4/2019 3:59 PM
Terminations	Termination Date	Insert	New Registration			10/4/2019 3:59 PM
Terminations	Termination Effective Date	Insert	New Registration			10/4/2019 3:59 PM
Terminations	Termination Reason	Insert	New Registration			10/4/2019 3:59 PM