Covered Entity Details

DSH330014R JAMAICA HOSPITAL MEDICAL CENTER (Active) - information as of 6/1/2025 4:51:07 AM

Main Details

Name

JAMAICA HOSPITAL MEDICAL CENTER

Subdivision Name

East New York - OP Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330014R

Medicare Provider Number

330014

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/7/2020

Participating Start Date

1/1/2021

Participating Approval Date

10/20/2020

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Jamaica Hospital
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291

Primary Contact

Jamaica Hospital Medical Center
Louis Cosenza, Director
(718) 206-6052

Addresses

Street Address

3080 Atlantic Ave
Brooklyn, NY 11208

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	00243852	1245370717

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
DSH330014A	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER	133-03 JAMAICA AVENUE	RICHMOND HILLS	NY	Active
DSH330014C	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOLLIS)	188-03 Jamaica Avenue	HOLLIS	NY	Active
DSH330014D	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (HOWARD BEACH)	156-10 CROSSBAY BLVD.	HOWARD BEACH	NY	Active
DSH330014E	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (JAMAICA)	149-18 JAMAICA AVENUE	JAMAICA	NY	Active
DSH330014F	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (RICHMOND HILL)	133-03 JAMAICA AVENUE	RICHMOND HILL	NY	Active
DSH330014G	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS FAMILY CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014H	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	MEDISYS SENIOR HEALTH CARE CENTER (OZONE PK CLOCKTOWER)	91-20 ATLANTIC AVENUE	OZONE PARK	NY	Active
DSH330014K	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	The Jamaica Hospital Mental Health Clinic	90-09 VanWyck Expressway	JAMAICA	NY	Active
DSH330014L	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	130-02 115th Avenue	South Ozone Park	NY	Active
DSH330014M	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	207-01 116TH AVENUE	CAMBRIA HEIGHTS	NY	Active
DSH330014N	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	JHMC-Extension Clinic	125-20 SUTPHIN BLVD	JAMAICA	NY	Active
DSH330014P	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	Jamaica Hospital Dental Clinic - Dental	134-20 Jamaica Ave	jamaica	NY	Active
DSH330014Q	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	St.Albans - clinic	111-20 Merrick Blvd	St.Albans	NY	Active
DSH330014R	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	East New York - OP Clinic	3080 Atlantic Ave	Brooklyn	NY	Active
DSH330014S	Child	DSH	JAMAICA HOSPITAL MEDICAL CENTER	HOLLIS TUDOR - CLINIC	200-16 HOLLIS AVE	SAINT ALBANS	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/29/2025 4:38 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00243852	1/29/2025 4:38 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	1/29/2025 4:38 PM
Details	Last Recertification Date	Update	Recertification	8/15/2023 12:00:08 PM	8/14/2024 9:51:06 AM	8/14/2024 9:51 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 10:36:42 AM	8/15/2023 12:00:08 PM	8/15/2023 12:00 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 3:28:11 PM	8/29/2022 10:36:42 AM	8/29/2022 10:36 AM
Details	Last Recertification Date	Update	Recertification		8/23/2021 3:28:11 PM	8/23/2021 3:28 PM
Details	State	Update		Approved	Active	1/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/20/2020 1:14 PM
Details	340B ID	Update	New Registration		DSH330014R	10/20/2020 1:14 PM
Details	Entity Subname	Update	New Registration	East New York	East New York - OP Clinic	10/20/2020 1:14 PM
Dates	Participating Approval Date	Update	New Registration		10/20/2020 1:14:18 PM	10/20/2020 1:14 PM
Details	State	Update	New Registration	Pending	Approved	10/20/2020 1:14 PM
Dates	Signed By Date	Update	New Registration		10/12/2020 12:28:00 PM	10/20/2020 1:14 PM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	10/20/2020 1:14 PM
Addresses	Main Address	Insert	New Registration		3080 Atlantic Ave Brooklyn, NY 11208	10/7/2020 12:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1245370717	10/7/2020 12:11 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	10/7/2020 12:11 PM
Contacts	Authorizing Official	Insert	New Registration		DOSS, MOUNIR F. EXECUTIVE VP & CFO Jamaica Hospital 7182066291	10/7/2020 12:11 PM
Contacts	Primary Contact	Insert	New Registration		Cosenza, Louis Director Jamaica Hospital Medical Center 7182066052	10/7/2020 12:11 PM
Details	Assistance Received From Date	Insert	New Registration			10/7/2020 12:11 PM
Details	Assistance Received To Date	Insert	New Registration			10/7/2020 12:11 PM
Details	Last Recertification Date	Insert	New Registration			10/7/2020 12:11 PM
Details	Grant Number	Insert	New Registration			10/7/2020 12:11 PM
Details	340B ID	Insert	New Registration			10/7/2020 12:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/7/2020 12:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/7/2020 12:11 PM
Details	Medicare Provider Number	Insert	New Registration		330014	10/7/2020 12:11 PM
Details	Entity Name	Insert	New Registration		JAMAICA HOSPITAL MEDICAL CENTER	10/7/2020 12:11 PM
Details	NOFO Number	Insert	New Registration			10/7/2020 12:11 PM
Details	Program Code	Insert	New Registration		DSH	10/7/2020 12:11 PM
Details	Entity Subname	Insert	New Registration		East New York	10/7/2020 12:11 PM
Dates	Participating Approval Date	Insert	New Registration			10/7/2020 12:11 PM
Details	State	Insert	New Registration		Pending	10/7/2020 12:11 PM
Dates	Registration Date	Insert	New Registration		10/7/2020 12:11:16 PM	10/7/2020 12:11 PM
Dates	Signed By Date	Insert	New Registration			10/7/2020 12:11 PM
Dates	Start Date	Insert	New Registration			10/7/2020 12:11 PM
Terminations	Termination Comments	Insert	New Registration			10/7/2020 12:11 PM
Terminations	Termination Date	Insert	New Registration			10/7/2020 12:11 PM
Terminations	Termination Effective Date	Insert	New Registration			10/7/2020 12:11 PM
Terminations	Termination Reason	Insert	New Registration			10/7/2020 12:11 PM