Covered Entity Details

RRC330126-02 Garnet Health Medical Center (Active) - information as of 4/26/2025 11:43:37 PM

Main Details

Name

Garnet Health Medical Center

Subdivision Name

Pavillion Substance Abuse Counseling - Substance Abuse Counseling

Type

Rural Referral Center

Rural

340B ID

RRC330126-02

Medicare Provider Number

330126

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2021

Participating Start Date

1/29/2021

Participating Approval Date

1/29/2021

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Garnet Health
James Grigg, CFO
(845) 333-2306

Primary Contact

Garnet Health Medical Center
Maria Russo, Director of Pharmacy
(845) 333-2043

Addresses

Street Address

75 Crystal Run Road
Suite 135
Middletown, NY 10940

Billing Address

Garnet Health Medical Center - Substance Abuse Counseling
707 East Main St
Middletown, NY 10940

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	02999939	1609875772
NJ		1609875772

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
RRC330126-01	Child	RRC	Garnet Health Medical Center	Pavillion Outpatient Behavioral Health - Behavioral Health	75 Crystal Run Road	Middletown	NY	Active
RRC330126-02	Child	RRC	Garnet Health Medical Center	Pavillion Substance Abuse Counseling - Substance Abuse Counseling	75 Crystal Run Road	Middletown	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	0010852450004; 0010852450005 (PA)		9/12/2024 9:13 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1609875772 (PA)		9/12/2024 9:13 AM
Details	Last Recertification Date	Update	Recertification	9/6/2023 1:20:24 PM	9/4/2024 10:22:36 AM	9/4/2024 10:22 AM
Addresses	Billing Address	Insert	Change Request		Garnet Health Medical Center - Substance Abuse Counseling 707 East Main St Middletown, NY 10940	2/1/2024 9:06 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 4:31:46 PM	9/6/2023 1:20:24 PM	9/6/2023 1:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/29/2022 11:15 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0010852450004; 0010852450005	9/29/2022 11:15 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	9/29/2022 11:15 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1609875772	9/29/2022 11:15 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	9/29/2022 11:15 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1609875772	9/29/2022 11:15 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	9/29/2022 11:15 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 3:28:28 PM	9/1/2022 4:31:46 PM	9/1/2022 4:31 PM
Contacts	Authorizing Official	Update	AO Change Request	Russo, Maria Director of Pharmacy Garnet Health Medical Center 8453332043	Grigg, James CFO Garnet Health 8453332306	7/14/2022 6:44 AM
Contacts	Authorizing Official	Update	Change Request	Tew, brian CEO Garnet Health Medical Center 8453332303	Russo, Maria Director of Pharmacy Garnet Health Medical Center 8453332043	9/28/2021 7:54 AM
Details	Entity Name	Update	Recertification	ORANGE REGIONAL MEDICAL CENTER	Garnet Health Medical Center	9/8/2021 10:36 AM
Details	Last Recertification Date	Update	Recertification		8/30/2021 3:28:28 PM	8/30/2021 3:28 PM
Details	State	Update	OPA Edit	Approved	Active	1/29/2021 12:09 PM
Dates	Start Date	Update	OPA Edit	4/1/2021 12:00:00 AM	1/29/2021 12:00:00 AM	1/29/2021 12:09 PM
Contacts	Signed By	Insert	New Registration		Tew, brian CEO Garnet Health Medical Center 8453332303	1/29/2021 12:06 PM
Details	340B ID	Update	New Registration		RRC330126-02	1/29/2021 12:06 PM
Details	Entity Subname	Update	New Registration	Pavillion Substance Abuse Counseling	Pavillion Substance Abuse Counseling - Substance Abuse Counseling	1/29/2021 12:06 PM
Dates	Participating Approval Date	Update	New Registration		1/29/2021 12:06:05 PM	1/29/2021 12:06 PM
Details	State	Update	New Registration	Pending	Approved	1/29/2021 12:06 PM
Dates	Signed By Date	Update	New Registration		1/28/2021 10:11:12 AM	1/29/2021 12:06 PM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	1/29/2021 12:06 PM
Addresses	Main Address	Insert	New Registration		75 Crystal Run Road Suite 135 Middletown, NY 10940	1/13/2021 3:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2021 3:39 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		02999939	1/13/2021 3:39 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/13/2021 3:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1609875772	1/13/2021 3:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	1/13/2021 3:39 PM
Contacts	Authorizing Official	Insert	New Registration		Tew, brian CEO Garnet Health Medical Center 8453332303	1/13/2021 3:39 PM
Contacts	Primary Contact	Insert	New Registration		Russo, Maria Director of Pharmacy Garnet Health Medical Center 8453332043	1/13/2021 3:39 PM
Details	Assistance Received From Date	Insert	New Registration			1/13/2021 3:39 PM
Details	Assistance Received To Date	Insert	New Registration			1/13/2021 3:39 PM
Details	Last Recertification Date	Insert	New Registration			1/13/2021 3:39 PM
Details	Grant Number	Insert	New Registration			1/13/2021 3:39 PM
Details	340B ID	Insert	New Registration			1/13/2021 3:39 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2021 3:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2021 3:39 PM
Details	Medicare Provider Number	Insert	New Registration		330126	1/13/2021 3:39 PM
Details	Entity Name	Insert	New Registration		ORANGE REGIONAL MEDICAL CENTER	1/13/2021 3:39 PM
Details	NOFO Number	Insert	New Registration			1/13/2021 3:39 PM
Details	Program Code	Insert	New Registration		RRC	1/13/2021 3:39 PM
Details	Entity Subname	Insert	New Registration		Pavillion Substance Abuse Counseling	1/13/2021 3:39 PM
Dates	Participating Approval Date	Insert	New Registration			1/13/2021 3:39 PM
Details	State	Insert	New Registration		Pending	1/13/2021 3:39 PM
Dates	Registration Date	Insert	New Registration		1/13/2021 3:39:23 PM	1/13/2021 3:39 PM
Dates	Signed By Date	Insert	New Registration			1/13/2021 3:39 PM
Dates	Start Date	Insert	New Registration			1/13/2021 3:39 PM
Terminations	Termination Comments	Insert	New Registration			1/13/2021 3:39 PM
Terminations	Termination Date	Insert	New Registration			1/13/2021 3:39 PM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2021 3:39 PM
Terminations	Termination Reason	Insert	New Registration			1/13/2021 3:39 PM