Covered Entity Details

RRC330140-16 ST. JOSEPHS HOSPITAL HEALTH CENTER (Terminated) - information as of 6/19/2025 11:53:46 PM

Main Details

Name

ST. JOSEPHS HOSPITAL HEALTH CENTER

Subdivision Name

Brittonfield Rehab PT Services - Physcial Therapy

Type

Rural Referral Center

Rural

Yes

340B ID

RRC330140-16

Medicare Provider Number

330140

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/12/2021

Participating Start Date

10/1/2021

Participating Approval Date

9/1/2021

Last Recertification Date

9/8/2023

Termination Date
Termination Reason

7/1/2024
Site closure

Contacts

Authorizing Official

St. Joseph's Hospital Health Center
Meredith Anne Price, Chief Financial Officer
(315) 448-5888

Primary Contact

St. Joseph's Hospital Health Center
Bernie E Delello, Director Pharmacy
(315) 448-5199

Addresses

Street Address

4939 Brittonfield PKWY
Building B Suite 103
East Syracuse, NY 13057

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	2995893	1508815333

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
RRC330140-01	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Adult OP Psych Services - Mental Health Clinic	742 James St	Syracuse	NY	Active
RRC330140-02	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Wound Care Services - Wound Care	4000 Medical Center Dr	Fayetteville	NY	Active
RRC330140-03	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	LINK North Syracuse - Mental Health Clinic	5100 W Taft Rd	Liverpool	NY	Active
RRC330140-04	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Infusion Center - Infusion Center	5100 W Taft Rd	Liverpool	NY	Terminated
RRC330140-05	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	OP Behaviorial Health at NE Med - Mental Health Clinic	4000 Medical Center Dr	Fayetteville	NY	Active
RRC330140-06	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	PCC West Physicians - Primary Care Clinic	321 Gifford St	Syracuse	NY	Terminated
RRC330140-07	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	PCC 742 James St. - Primary Care Clinic	742 James St	Syracuse	NY	Terminated
RRC330140-08	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Northeast Surgery Center - Ambulatory Surgery Center	4208 Medical Center Dr	Fayetteville	NY	Active
RRC330140-09	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Childrens OP Psych Services - Pediatric Mental Health Clinic	742 James St	Syracuse	NY	Active
RRC330140-10	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	PCC Physicians at 742 James St - Primary Care Clinic	742 James St	Syracuse	NY	Terminated
RRC330140-11	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Sleep Lab NE - Sleep Lab	7246 Janus Park Drive	Liverpool	NY	Active
RRC330140-12	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Westside Family Health Center - Primary Care	321 Gifford St	Syracuse	NY	Active
RRC330140-13	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	OP Behaviorial Health Integrated Care - Mental Health Clinic	321 Gifford St	Syracuse	NY	Active
RRC330140-14	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	OP Behaviorial Health at NE Med - Mental Health Clinic	4104 Medical Center Dr	Fayetteville	NY	Terminated
RRC330140-15	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	MCHC/OB - OB Clinic	321 Gifford St	Syracuse	NY	Terminated
RRC330140-16	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Brittonfield Rehab PT Services - Physcial Therapy	4939 Brittonfield PKWY	East Syracuse	NY	Terminated
RRC330140-17	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Northeast Physical Therapy - Physcial Therapy	4000 Medical Center Dr	Fayetteville	NY	Active
RRC330140-18	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Janus Park Rehab Services - Cardiac Rehab	7246 Janus Park Drive	Liverpool	NY	Active
RRC330140-19	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	Westside Family Health Center - Pediatrics - Pediatric clinic	321 Gifford St	Syracuse	NY	Terminated
RRC330140-20	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	North Surgery Center - Ambulatory Surgery Center	5100 W Taft Rd	Liverpool	NY	Terminated
RRC330140-21	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	MCHC OB Physicians - OB Clinic	321 Gifford St	Syracuse	NY	Terminated
RRC330140-22	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	PROS - PROS - Personalized Recovery Oriented Services	742 James St	Syracuse	NY	Active
RRC330140-23	Child	RRC	ST. JOSEPHS HOSPITAL HEALTH CENTER	St. Josephs Health Cardiovascular Institute Vascular - Vascular Access Center	104 Union Avenue	Syracuse	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Price, Meredith Anne Chief Financial Officer St. Joseph's Hospital Health Center 3154885888	Price, Meredith Anne Chief Financial Officer St. Joseph's Hospital Health Center 3154485888	1/30/2025 3:44 PM
Contacts	Signed By	Update	Profile Change Request	Price, Meredith Anne Chief Financial Officer St. Joseph's Hospital Health Center 3154885888	Price, Meredith Anne Chief Financial Officer St. Joseph's Hospital Health Center 3154485888	1/30/2025 3:44 PM
Details	State	Update		To Be Terminated	Terminated	7/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/1/2021 12:00:00 AM	4/12/2024 12:54 PM
Details	State	Update	Termination Request	Active	To Be Terminated	4/12/2024 12:54 PM
Terminations	Termination Date	Update	Termination Request		7/1/2024 12:00:00 AM	4/12/2024 12:54 PM
Terminations	Termination Effective Date	Update	Termination Request		1/1/2021 12:00:00 AM	4/12/2024 12:54 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	4/12/2024 12:54 PM
Contacts	Primary Contact	Update	Group Change Request	Mecomonaco, Michele Director of Reimbursment St Joseph's Hospital Health Center 3157032154	Delello, Bernie E Director Pharmacy St. Joseph's Hospital Health Center 3154485199	3/20/2024 6:56 AM
Details	Last Recertification Date	Update	Recertification	9/9/2022 3:49:51 PM	9/8/2023 3:13:07 PM	9/8/2023 3:13 PM
Details	Last Recertification Date	Update	Recertification		9/9/2022 3:49:51 PM	9/9/2022 3:49 PM
Details	State	Update		Approved	Active	10/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Price, Meredith Anne Chief Financial Officer St. Joseph's Hospital Health Center 3154885888	9/1/2021 9:46 AM
Details	340B ID	Update	New Registration		RRC330140-16	9/1/2021 9:46 AM
Details	Entity Subname	Update	New Registration	Brittonfield Rehab PT Services	Brittonfield Rehab PT Services - Physcial Therapy	9/1/2021 9:46 AM
Dates	Participating Approval Date	Update	New Registration		9/1/2021 9:46:30 AM	9/1/2021 9:46 AM
Details	State	Update	New Registration	Pending	Approved	9/1/2021 9:46 AM
Dates	Signed By Date	Update	New Registration		7/15/2021 8:17:37 AM	9/1/2021 9:46 AM
Dates	Start Date	Update	New Registration		10/1/2021 12:00:00 AM	9/1/2021 9:46 AM
Addresses	Main Address	Insert	New Registration		4939 Brittonfield PKWY Building B Suite 103 East Syracuse, NY 13057	7/12/2021 10:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2021 10:48 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2995893	7/12/2021 10:48 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	7/12/2021 10:48 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1508815333	7/12/2021 10:48 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	7/12/2021 10:48 AM
Contacts	Primary Contact	Insert	New Registration		Mecomonaco, Michele Director of Reimbursment St Joseph's Hospital Health Center 3157032154	7/12/2021 10:48 AM
Contacts	Authorizing Official	Insert	New Registration		Price, Meredith Anne Chief Financial Officer St. Joseph's Hospital Health Center 3154885888	7/12/2021 10:48 AM
Details	Assistance Received From Date	Insert	New Registration			7/12/2021 10:48 AM
Details	Assistance Received To Date	Insert	New Registration			7/12/2021 10:48 AM
Details	Last Recertification Date	Insert	New Registration			7/12/2021 10:48 AM
Details	Grant Number	Insert	New Registration			7/12/2021 10:48 AM
Details	340B ID	Insert	New Registration			7/12/2021 10:48 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/12/2021 10:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/12/2021 10:48 AM
Details	Medicare Provider Number	Insert	New Registration		330140	7/12/2021 10:48 AM
Details	Entity Name	Insert	New Registration		ST. JOSEPHS HOSPITAL HEALTH CENTER	7/12/2021 10:48 AM
Details	NOFO Number	Insert	New Registration			7/12/2021 10:48 AM
Details	Program Code	Insert	New Registration		RRC	7/12/2021 10:48 AM
Details	Entity Subname	Insert	New Registration		Brittonfield Rehab PT Services	7/12/2021 10:48 AM
Dates	Participating Approval Date	Insert	New Registration			7/12/2021 10:48 AM
Details	State	Insert	New Registration		Pending	7/12/2021 10:48 AM
Dates	Registration Date	Insert	New Registration		7/12/2021 10:48:31 AM	7/12/2021 10:48 AM
Dates	Signed By Date	Insert	New Registration			7/12/2021 10:48 AM
Dates	Start Date	Insert	New Registration			7/12/2021 10:48 AM
Terminations	Termination Comments	Insert	New Registration			7/12/2021 10:48 AM
Terminations	Termination Date	Insert	New Registration			7/12/2021 10:48 AM
Terminations	Termination Effective Date	Insert	New Registration			7/12/2021 10:48 AM
Terminations	Termination Reason	Insert	New Registration			7/12/2021 10:48 AM