Covered Entity Details

DSH310039K RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION (Active) - information as of 6/12/2025 6:02:27 AM

Main Details

Name

RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION

Subdivision Name

Old Bridge Medical Center Operating Room - Operating Room

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310039K

Medicare Provider Number

310039

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2021

Participating Start Date

7/1/2021

Participating Approval Date

4/23/2021

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Raritan Bay Medical Center
Patricia Carroll, President
(732) 324-5000

Primary Contact

Hackensack Meridian Health
Sheba Saggu, 340B Program Manager
(732) 324-4909

Addresses

Street Address

One Hospital Plaza
Old Bridge, NJ 08857

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
NJ	0634328	1356828172

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
DSH310039A	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Yewasis - Orthopedic Clinic	466 New Brunswick Avenue	Perth Amboy	NJ	Terminated
DSH310039B	Child	DSH	RARITAN BAY MEDICAL CENTER	Medical Arts Building - Radiology	Three Hospital Plaza	Old Bridge	NJ	Terminated
DSH310039C	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Medical Arts Building - Medical Day Stay	Three Hospital Plaza	Old Bridge	NJ	Active
DSH310039D	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Medical Office Building - Same Day Surgery	Two Hospital Plaza	Old Bridge	NJ	Active
DSH310039E	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Old Bridge Medical Center	One Hospital Plaza	Old Bridge	NJ	Terminated
DSH310039F	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Medical Arts Building -Radiology - Imaging Services	2 Hosptial Plaza	Old Bridge	NJ	Terminated
DSH310039G	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Medical Arts Building- Radiology - Imaging Services	2 Hospital Plaza	Old Bridge	NJ	Terminated
DSH310039H	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Medical Arts Building- Radiology - Imaging Services	2 Hospital Plaza	Old Bridge	NJ	Terminated
DSH310039J	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Medical Arts Building- Radiology - Imaging Services	2 Hospital Plaza	Old Bridge	NJ	Terminated
DSH310039K	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Old Bridge Medical Center Operating Room - Operating Room	One Hospital Plaza	Old Bridge	NJ	Active
DSH310039L	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Old Bridge Medical Center Respiratory Therapy - Respiratory Therapy	One Hospital Plaza	Old Bridge	NJ	Active
DSH310039M	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Old Bridge Medical Center Electrocardiology - Electrocardiology	One Hospital Plaza	Old Bridge	NJ	Active
DSH310039N	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Old Bridge Medical Center Endoscopy - Endoscopy	One Hospital Plaza	Old Bridge	NJ	Active
DSH310039P	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Old Bridge Medical Center Emergency - Emergency	One Hospital Plaza	Old Bridge	NJ	Active
DSH310039Q	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Old Bridge Medical Center Observation Beds - Medical/Surgical	Two Hospital Plaza	Oldbridge	NJ	Active
DSH310039R	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	MRI	Two Hospital Plaza	Old Bridge	NJ	Active
DSH310039S	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	OB-Radiology - Radiology	One & Two Hospital plaza	Old Bridge	NJ	Active
DSH310039T	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	OB-Cat Scan - Cat Scan	One & Two Hospital plaza	Old Bridge	NJ	Active
DSH310039U	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	Ob- Ultrasound - Ultrasound	Two Hospital Plaza	Old Bridge	NJ	Active
DSH310039V	Child	DSH	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	OB-Nuclear Medicine - Nuclear Medicine	Two Hospital Plaza	Old Bridge	NJ	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Saggu, Sheba 340 Program Administrator Hackensack Meridian Health 7323244909	Saggu, Sheba 340B Program Manager Hackensack Meridian Health 7323244909	4/14/2025 9:52 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	008100318 (CT)		8/23/2024 12:01 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	003220388A (GA)		8/23/2024 12:01 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1356828172 (NC)		8/23/2024 12:01 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	100093090 (WI)		8/23/2024 12:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/23/2024 12:01 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0634328	8/23/2024 12:01 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	8/23/2024 12:01 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1356828172 (CT)		8/23/2024 12:01 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1356828172 (GA)		8/23/2024 12:01 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1356828172 (NC)		8/23/2024 12:01 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1356828172 (WI)		8/23/2024 12:01 PM
Details	Last Recertification Date	Update	Recertification	9/6/2023 10:21:46 AM	8/23/2024 12:01:27 PM	8/23/2024 12:01 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 1:29:32 PM	9/6/2023 10:21:46 AM	9/6/2023 10:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008100318	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003220388A	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1356828172	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100093090	6/19/2023 12:44 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	6/19/2023 12:44 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1356828172	6/19/2023 12:44 PM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	6/19/2023 12:44 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1356828172	6/19/2023 12:44 PM
Medicaid Billing	NPI: State	Insert	Change Request		CT	6/19/2023 12:44 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1356828172	6/19/2023 12:44 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	6/19/2023 12:44 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1356828172	6/19/2023 12:44 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	6/19/2023 12:44 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1356828172	6/19/2023 12:44 PM
Medicaid Billing	NPI: State	Insert	Change Request		WI	6/19/2023 12:44 PM
Contacts	Authorizing Official	Update	AO Change Request	Distanislao, William Interim President, Chief Hospital Executive Executive Site Director for Old Bridge Medical Center & Vice President of Operations Hackensack Meridian Health 7323604167	Carroll, Patricia President Raritan Bay Medical Center 7323245000	6/15/2023 11:39 AM
Details	Last Recertification Date	Update	Recertification	9/7/2021 12:30:24 PM	8/29/2022 1:29:32 PM	8/29/2022 1:29 PM
Contacts	Authorizing Official	Update	AO Change Request	Pipas, Frank EVP Financial Services Hackensack Merdian Health 8488884687	Distanislao, William Interim President, Chief Hospital Executive Executive Site Director for Old Bridge Medical Center & Vice President of Operations Hackensack Meridian Health 7323604167	2/22/2022 12:19 PM
Details	Entity Subname	Update	Change Request	OldBridge Division Operating Room - Operating Room	Old Bridge Medical Center Operating Room - Operating Room	11/15/2021 9:42 AM
Details	Last Recertification Date	Update	Recertification		9/7/2021 12:30:24 PM	9/7/2021 12:30 PM
Details	State	Update		Approved	Active	7/1/2021 12:01 AM
Contacts	Primary Contact	Update	Change Request	Saggu, Sheba 340B Administrator DSH310039 7323244909	Saggu, Sheba 340 Program Administrator Hackensack Meridian Health 7323244909	4/29/2021 4:57 PM
Contacts	Signed By	Insert	New Registration		Pipas, Frank EVP Financial Services Hackensack Merdian Health 8488884687	4/23/2021 11:04 AM
Details	340B ID	Update	New Registration		DSH310039K	4/23/2021 11:04 AM
Details	Entity Name	Update	New Registration	RARITAN BAY MEDICAL CENTER	RARITAN BAY MEDICAL CENTER/ HMH HOSPITALS CORPORATION	4/23/2021 11:04 AM
Details	Entity Subname	Update	New Registration	OldBridge Division Operating Room	OldBridge Division Operating Room - Operating Room	4/23/2021 11:04 AM
Dates	Participating Approval Date	Update	New Registration		4/23/2021 11:04:22 AM	4/23/2021 11:04 AM
Details	State	Update	New Registration	Pending	Approved	4/23/2021 11:04 AM
Dates	Signed By Date	Update	New Registration		4/21/2021 10:21:31 AM	4/23/2021 11:04 AM
Dates	Start Date	Update	New Registration		7/1/2021 12:00:00 AM	4/23/2021 11:04 AM
Contacts	Authorizing Official	Update	AO Change Request	SHANAHAN, THOMAS G. Executive VP, COO Raritan Bay Medical Center 7323245401	Pipas, Frank EVP Financial Services Hackensack Merdian Health 8488884687	4/15/2021 6:18 PM
Addresses	Main Address	Insert	New Registration		One Hospital Plaza Old Bridge, NJ 08857	4/15/2021 4:52 PM
Contacts	Authorizing Official	Insert	New Registration		SHANAHAN, THOMAS G. Executive VP, COO Raritan Bay Medical Center 7323245401	4/15/2021 4:52 PM
Contacts	Primary Contact	Insert	New Registration		Saggu, Sheba 340B Administrator DSH310039 7323244909	4/15/2021 4:52 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2021 4:52 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2021 4:52 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2021 4:52 PM
Details	Grant Number	Insert	New Registration			4/15/2021 4:52 PM
Details	340B ID	Insert	New Registration			4/15/2021 4:52 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2021 4:52 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2021 4:52 PM
Details	Medicare Provider Number	Insert	New Registration		310039	4/15/2021 4:52 PM
Details	Entity Name	Insert	New Registration		RARITAN BAY MEDICAL CENTER	4/15/2021 4:52 PM
Details	NOFO Number	Insert	New Registration			4/15/2021 4:52 PM
Details	Program Code	Insert	New Registration		DSH	4/15/2021 4:52 PM
Details	Entity Subname	Insert	New Registration		OldBridge Division Operating Room	4/15/2021 4:52 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2021 4:52 PM
Details	State	Insert	New Registration		Pending	4/15/2021 4:52 PM
Dates	Registration Date	Insert	New Registration		4/15/2021 4:52:12 PM	4/15/2021 4:52 PM
Dates	Signed By Date	Insert	New Registration			4/15/2021 4:52 PM
Dates	Start Date	Insert	New Registration			4/15/2021 4:52 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2021 4:52 PM
Terminations	Termination Date	Insert	New Registration			4/15/2021 4:52 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2021 4:52 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2021 4:52 PM