Covered Entity Details

DSH330028J RICHMOND UNIVERSITY MEDICAL CENTER (Active) - information as of 5/1/2025 11:49:24 PM

Main Details

Name

RICHMOND UNIVERSITY MEDICAL CENTER

Subdivision Name

Outpatient Cancer Center - Outpatient Cancer Treatment Services

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330028J

Medicare Provider Number

330028

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

3/26/2020

Participating Start Date

3/27/2020

Participating Approval Date

3/27/2020

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Richmond Medical Center
David Stephen Murray, Chief Financial Officer
(718) 818-3295

Primary Contact

Richmond Medical Center
Nicholas Galeno, 340B Compliance Manager
(718) 818-2077

Addresses

Street Address

355 Bard Avenue
Staten Island, NY 10310

Billing Address

Richmond University Medical Center
355 BARD AVENUE
STATEN ISLAND, NY 10310

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	00248820	1740389154

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
DSH330028A	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	BAYLEY SETON	75 VANDERBILT AVENUE	STATEN ISLAND	NY	Terminated
DSH330028AA	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Hematology / Oncology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AB	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adolescent Medical Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AC	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Medical Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AD	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Pulmonary Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AE	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Vascular Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AF	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Endocrine Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AG	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC ID Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AH	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Nephrology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AJ	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Neurology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AK	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric GI Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028AL	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Renal Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028D	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	Silberstein SubstanceTREATMENT EXT. CLINIC	1130 South Avenue	STATEN ISLAND	NY	Active
DSH330028F	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	DAY TREATMENT PROGRAM (SI-CDT)	1130 South Ave.	STATEN ISLAND	NY	Active
DSH330028G	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	St. GEORGE TREATMENT PROGRAM	1130 South Ave	STATEN ISLAND	NY	Active
DSH330028H	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	St. GEORGE -MICA	1130 South Ave	STATEN ISLAND	NY	Active
DSH330028I	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	COMMUNITY TREATMENT Center	1130 South Ave	STATEN ISLAND	NY	Active
DSH330028J	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	Outpatient Cancer Center - Outpatient Cancer Treatment Services	355 Bard Avenue	Staten Island	NY	Active
DSH330028K	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Newborn Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028L	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Surgery Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028M	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Thoracic Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Terminated
DSH330028N	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Influenza Vaccine Administration	800 CASTLETON AVE	STATEN ISLAND	NY	Terminated
DSH330028P	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Hematology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028Q	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Pulmonary Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028R	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Cardiology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028S	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Adult Gastroenterology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028T	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Neurological Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028U	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Clinic Ref	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028V	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Orthopedic Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028W	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Continuing Care Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028X	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Pediatric Endo Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028Y	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Surgery Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active
DSH330028Z	Child	DSH	RICHMOND UNIVERSITY MEDICAL CENTER	CASTLETON - RUMC Urology Clinic	800 CASTLETON AVE	STATEN ISLAND	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	parnas, zarina clinical pharmacy supervisor richmond university medical center 7188183272	Galeno, Nicholas 340B Compliance Manager Richmond Medical Center 7188182077	3/19/2025 7:19 AM
Details	Last Recertification Date	Update	Recertification	9/11/2023 7:51:10 PM	8/19/2024 7:56:34 AM	8/19/2024 7:56 AM
Addresses	Main Address	Update	Change Request	1000 South Avenue Staten Island, NY 10314	355 Bard Avenue Staten Island, NY 10310	10/2/2023 7:02 AM
Details	Last Recertification Date	Update	Recertification	9/9/2022 9:54:32 AM	9/11/2023 7:51:10 PM	9/11/2023 7:51 PM
Details	Last Recertification Date	Update	Recertification	8/25/2021 7:56:16 AM	9/9/2022 9:54:32 AM	9/9/2022 9:54 AM
Details	Last Recertification Date	Update	Recertification	8/26/2020 5:22:46 PM	8/25/2021 7:56:16 AM	8/25/2021 7:56 AM
Contacts	Authorizing Official	Update	AO Change Request	Tamburello, Leonardo Director of Finance Richmond Medical Center 7188184540	Murray, David Stephen Chief Financial Officer Richmond Medical Center 7188183295	8/20/2021 2:57 PM
Contacts	Primary Contact	Update	Change Request	Gilbride, Angela Director of Pharmacy Richmond University Medical Center 7188182077	parnas, zarina clinical pharmacy supervisor richmond university medical center 7188183272	1/8/2021 4:42 PM
Contacts	Authorizing Official	Update	AO Change Request	Saporito, Joseph CFO Richmond University Medical Center 7188183295	Tamburello, Leonardo Director of Finance Richmond Medical Center 7188184540	10/26/2020 6:51 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1740389154 ( )		8/26/2020 5:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740389154	8/26/2020 5:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/26/2020 5:22 PM
Details	Last Recertification Date	Update	Recertification		8/26/2020 5:22:46 PM	8/26/2020 5:22 PM
Details	State	Update	OPA Edit	Approved	Active	3/27/2020 1:00 PM
Dates	Start Date	Update	OPA Edit	4/1/2020 12:00:00 AM	3/27/2020 12:00:00 AM	3/27/2020 1:00 PM
Contacts	Signed By	Insert	New Registration		Saporito, Joseph CFO Richmond University Medical Center 7188183295	3/27/2020 12:59 PM
Details	340B ID	Update	New Registration		DSH330028J	3/27/2020 12:59 PM
Details	Entity Subname	Update	New Registration	Outpatient Cancer Center	Outpatient Cancer Center - Outpatient Cancer Treatment Services	3/27/2020 12:59 PM
Dates	Participating Approval Date	Update	New Registration		3/27/2020 12:59:51 PM	3/27/2020 12:59 PM
Details	State	Update	New Registration	Pending	Approved	3/27/2020 12:59 PM
Dates	Signed By Date	Update	New Registration		3/27/2020 12:06:28 PM	3/27/2020 12:59 PM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	3/27/2020 12:59 PM
Addresses	Main Address	Insert	New Registration		1000 South Avenue Staten Island, NY 10314	3/26/2020 4:31 PM
Addresses	Billing Address	Insert	New Registration		Richmond University Medical Center 355 BARD AVENUE STATEN ISLAND, NY 10310	3/26/2020 4:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	3/26/2020 4:31 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00248820	3/26/2020 4:31 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	3/26/2020 4:31 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1740389154	3/26/2020 4:31 PM
Contacts	Authorizing Official	Insert	New Registration		Saporito, Joseph CFO Richmond University Medical Center 7188183295	3/26/2020 4:31 PM
Contacts	Primary Contact	Insert	New Registration		Gilbride, Angela Director of Pharmacy Richmond University Medical Center 7188182077	3/26/2020 4:31 PM
Details	Last Recertification Date	Insert	New Registration			3/26/2020 4:31 PM
Details	Grant Number	Insert	New Registration			3/26/2020 4:31 PM
Details	340B ID	Insert	New Registration			3/26/2020 4:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			3/26/2020 4:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			3/26/2020 4:31 PM
Details	Medicare Provider Number	Insert	New Registration		330028	3/26/2020 4:31 PM
Details	Entity Name	Insert	New Registration		RICHMOND UNIVERSITY MEDICAL CENTER	3/26/2020 4:31 PM
Details	Program Code	Insert	New Registration		DSH	3/26/2020 4:31 PM
Details	Entity Subname	Insert	New Registration		Outpatient Cancer Center	3/26/2020 4:31 PM
Dates	Participating Approval Date	Insert	New Registration			3/26/2020 4:31 PM
Details	State	Insert	New Registration		Pending	3/26/2020 4:31 PM
Dates	Registration Date	Insert	New Registration		3/26/2020 4:31:22 PM	3/26/2020 4:31 PM
Dates	Signed By Date	Insert	New Registration			3/26/2020 4:31 PM
Dates	Start Date	Insert	New Registration			3/26/2020 4:31 PM
Terminations	Termination Comments	Insert	New Registration			3/26/2020 4:31 PM
Terminations	Termination Date	Insert	New Registration			3/26/2020 4:31 PM
Terminations	Termination Effective Date	Insert	New Registration			3/26/2020 4:31 PM
Terminations	Termination Reason	Insert	New Registration			3/26/2020 4:31 PM