Covered Entity Details

DSH330350M UNIVERSITY HOSPITAL OF BROOKLYN (Active) - information as of 6/16/2025 11:20:31 PM

Main Details

Name

UNIVERSITY HOSPITAL OF BROOKLYN

Subdivision Name

SUNY-Parkside Dialysis Center - Dialysis

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330350M

Medicare Provider Number

330350

Outpatient Facility Provider Number

333544

Additional Details

Current Program Status

Active

Registration Date

4/10/2020

Participating Start Date

7/1/2020

Participating Approval Date

5/13/2020

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

SUNY Downstate
Sean Patrick Smith, Senior Associate Vice President & Deputy Chief Financial Officer
(718) 826-4943

Primary Contact

UNIVERSITY HOSPITAL OF BROOKLYN
Hossameldin Ghanem, Pharmacy 340B Manager
(718) 270-7648

Addresses

Street Address

710 Parkside Avenue
Brooklyn, NY 11203

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	02998676	1528027414

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
DSH330350A	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	SUNY DOWNSTATE AT BAY RIDGE	699 92ND STREET	BROOKLYN, NEW YORK	NY	Terminated
DSH330350B	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	Ambulatory Surgery Center at Bay Ridge	699 92nd Street	Brooklyn	NY	Terminated
DSH330350C	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	Endoscopy Clinic at Bay Ridge	699 92nd Street	Brooklyn	NY	Terminated
DSH330350D	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	Urgent Care Center at Bay Ridge	699 92nd Street	Brooklyn	NY	Terminated
DSH330350E	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	Center for Health Services - Midwood - Ophthalmology	2171 Nostrand Ave	Brooklyn	NY	Terminated
DSH330350F	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	UHB Family Health Services - Family Health	840 Lefferts Ave	brooklyn	NY	Terminated
DSH330350G	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	PS 142 Stranahan - School Based Hospital Extension Clinic	610 Henry Street	Brooklyn	NY	Terminated
DSH330350H	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	PS 13 - School Based Hospital Extension Clinic	557 Pennsylvania Ave	Brookyn	NY	Terminated
DSH330350J	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	MS 293 Global Studies - School Based Hospital Extension Clinic	284 Baltic Street	Brooklyn	NY	Terminated
DSH330350K	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	PS 38 - School Based Hospital Extension Clinic	450 Pacific Street	Brooklyn	NY	Terminated
DSH330350L	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	MS 51 -Alexander - School Based Hospital Extension Clinic	350 5th Ave	brooklyn	NY	Terminated
DSH330350M	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	SUNY-Parkside Dialysis Center - Dialysis	710 Parkside Avenue	Brooklyn	NY	Active
DSH330350N	Child	DSH	UNIVERSITY HOSPITAL OF BROOKLYN	SUNY Downstate Family Medicine clinic - Family Health	253 Empire Blvd	Brooklyn	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 10:43:53 AM	8/22/2024 9:29:41 AM	8/22/2024 9:29 AM
Details	Last Recertification Date	Update	Recertification	9/8/2022 8:27:05 AM	8/17/2023 10:43:53 AM	8/17/2023 10:43 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 1:40:44 PM	9/8/2022 8:27:05 AM	9/8/2022 8:27 AM
Contacts	Authorizing Official	Update	AO Change Request	Miller, Richard Bayard Chief Financial OIfficer University Hospital of Brooklyn 7182704901	Smith, Sean Patrick Senior Associate Vice President & Deputy Chief Financial Officer SUNY Downstate 7188264943	9/22/2021 12:04 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 11:05:45 AM	9/8/2021 1:40:44 PM	9/8/2021 1:40 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1528027414 ( )		9/4/2020 11:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1528027414	9/4/2020 11:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/4/2020 11:05 AM
Details	Last Recertification Date	Update	Recertification		9/4/2020 11:05:45 AM	9/4/2020 11:05 AM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Miller, Richard Bayard Chief Financial OIfficer University Hospital of Brooklyn 7182704901	5/13/2020 12:55 PM
Details	340B ID	Update	New Registration		DSH330350M	5/13/2020 12:55 PM
Details	Entity Subname	Update	New Registration	SUNY-Parkside Dialysis Center	SUNY-Parkside Dialysis Center - Dialysis	5/13/2020 12:55 PM
Dates	Participating Approval Date	Update	New Registration		5/13/2020 12:55:42 PM	5/13/2020 12:55 PM
Details	State	Update	New Registration	Pending	Approved	5/13/2020 12:55 PM
Dates	Signed By Date	Update	New Registration		4/10/2020 4:48:01 PM	5/13/2020 12:55 PM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	5/13/2020 12:55 PM
Addresses	Main Address	Insert	New Registration		710 Parkside Avenue Brooklyn, NY 11203	4/10/2020 2:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2020 2:04 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		02998676	4/10/2020 2:04 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	4/10/2020 2:04 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528027414	4/10/2020 2:04 PM
Contacts	Authorizing Official	Insert	New Registration		Miller, Richard Bayard Chief Financial OIfficer University Hospital of Brooklyn 7182704901	4/10/2020 2:04 PM
Contacts	Primary Contact	Insert	New Registration		Ghanem, Hossameldin Pharmacy 340B Manager UNIVERSITY HOSPITAL OF BROOKLYN 7182707648	4/10/2020 2:04 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2020 2:04 PM
Details	Grant Number	Insert	New Registration			4/10/2020 2:04 PM
Details	340B ID	Insert	New Registration			4/10/2020 2:04 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2020 2:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2020 2:04 PM
Details	Medicare Provider Number	Insert	New Registration		330350	4/10/2020 2:04 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY HOSPITAL OF BROOKLYN	4/10/2020 2:04 PM
Details	Program Code	Insert	New Registration		DSH	4/10/2020 2:04 PM
Details	Entity Subname	Insert	New Registration		SUNY-Parkside Dialysis Center	4/10/2020 2:04 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2020 2:04 PM
Details	State	Insert	New Registration		Pending	4/10/2020 2:04 PM
Dates	Registration Date	Insert	New Registration		4/10/2020 2:04:21 PM	4/10/2020 2:04 PM
Dates	Signed By Date	Insert	New Registration			4/10/2020 2:04 PM
Dates	Start Date	Insert	New Registration			4/10/2020 2:04 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2020 2:04 PM
Terminations	Termination Date	Insert	New Registration			4/10/2020 2:04 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2020 2:04 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2020 2:04 PM