340B Drug Pricing Program Database


DSH330160Y STATEN ISLAND UNIVERSITY HOSPITAL (Active) - information as of 6/2/2025 8:32:52 AM

Main Details
STATEN ISLAND UNIVERSITY HOSPITAL
Medical Arts Pavilion - Rehab Services
Disproportionate Share Hospital
No
DSH330160Y
330160


Additional Details
Active
10/15/2021
1/1/2022
11/29/2021
8/19/2024

Contacts

Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058

Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720

Addresses

242 Mason Avenue
1st floor
Staten Island, NY 10305

Staten Island University Hospital
475 Seaview Avenue
Staten Island, NY 10305


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
OH22040821407877137
NY00244202 (NY),05380841 (NY)1407877137,1144714171
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailLONG ISLAND JEWISH MEDICAL CENTER AT HOMVIVO HEALTH PHARMACY AT HOME 225 COMMUNITY DR STE 140
GREAT NECKNY11021-550611/20/202301/01/2024  01/01/2024
Contract DetailTRUE NORTH HEALTH PHARMACY, INCDBA: VIVO HEALTH PHARMACY AT CFAM 450 LAKEVILLE RD
LAKE SUCCESSNY1104211/20/202301/01/2024  01/01/2024
Contract DetailTRUE NORTH HEALTH PHARMACY, INC.DBA: VIVO HEALTH SPECIALTY PHARMACY 225 COMMUNITY DR STE 100
GREAT NECKNY11021-550611/20/202301/01/2024  01/01/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH330160AChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth-Emergency Department375 SEGUINE AVESTATEN ISLANDNYActive
DSH330160AAChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth-Vascular Lab - Vascular Lab375 Seguine AvenueStaten IslandNYActive
DSH330160ABChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Eye Clinic242 Mason AvenueStaten IslandNYActive
DSH330160ACChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth-Radiology - Radiology Diagnostic375 Seguine AvenueStaten IslandNYActive
DSH330160ADChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth-Ambulatory Surgery - Ambulatory Surgery375 Seguine AvenueStaten IslandNYActive
DSH330160AEChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion-Ambulatory Surgery - Ambulatory Surgery256 Mason AveStaten IslandNYActive
DSH330160AFChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Hearing and Speech242 Mason AvenueStaten IslandNYActive
DSH330160AGChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion-Coumadin Clinic - Clinic256 Mason AveStaten IslandNYActive
DSH330160AHChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Urology242 Mason AvenueStaten IslandNYActive
DSH330160AJChildDSHSTATEN ISLAND UNIVERSITY HOSPITALOutpatient First Episode Clinic - Clinic450 Seaview AvenueStaten IslandNYActive
DSH330160AKChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Adolescent242 Mason AvenueStaten IslandNYActive
DSH330160ALChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth-Interventional Radiology - Radiology Diagnostic375 Seguine AvenueStaten IslandNYActive
DSH330160AMChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Diabetic Treatment - Clinic242 Mason AvenueStaten IslandNYActive
DSH330160ANChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Clinic242 Mason AvenueStaten IslandNYActive
DSH330160APChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion-Laboratory - Laboratory256 Mason AveStaten IslandNYActive
DSH330160AQChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion-Oncology - Cancer Treatment256 Mason AveStaten IslandNYTerminated
DSH330160ARChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Early Intervention - Physical Therapy256C Mason AvenueStaten IslandNYActive
DSH330160ASChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - VERRAZANO RADIOLOGY - Radiology Diagnostic256 MASON AVESTATEN ISLANDNYActive
DSH330160ATChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Allergy - Clinic242 Mason AvenueStaten IslandNYActive
DSH330160AUChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Geriatrics - Geriatrics242 Mason AvenueStaten IslandNYActive
DSH330160AVChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Physical Therapy - Physical Therapy256C Mason AvenueStaten IslandNYActive
DSH330160AWChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Pediatrics - Pediatrics242 Mason AvenueStaten IslandNYActive
DSH330160AXChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Orthopedics - Orthopedics242 Mason AveStaten IslandNYActive
DSH330160AYChildDSHSTATEN ISLAND UNIVERSITY HOSPITALPost Covid Recovery Center - Clinic500 Seaview AvenueStaten IslandNYTerminated
DSH330160AZChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth - Cardiac Electrophysiology375 SEGUINE AVENUESTATEN ISLANDNYActive
DSH330160BChildDSHSTATEN ISLAND UNIVERSITY HOSPITALCanarsie Chemical Dependency Treatment Program567 East 105th StreetBrooklynNYActive
DSH330160BAChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSTATEN ISLAND UNIVERSITY HOSPITAL - Medical Arts Pavilion - Laboratory Services242 MASON AVENUESTATEN ISLANDNYActive
DSH330160BBChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth - Respiratory Therapy375 SEGUINE AVENUESTATEN ISLANDNYActive
DSH330160BCChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSTATEN ISLAND UNIVERSITY HOSPITAL - Diabetes Wellness Clinic440 SEAVIEW AVENUESTATEN ISLANDNYActive
DSH330160CChildDSHSTATEN ISLAND UNIVERSITY HOSPITALChemical Dependency Treatment Program111 Water StreetStaten IslandNYActive
DSH330160DChildDSHSTATEN ISLAND UNIVERSITY HOSPITALConey Island Multi Service Center425-427 Coney Island AvenueBrooklynNYTerminated
DSH330160EChildDSHSTATEN ISLAND UNIVERSITY HOSPITALPsych/Alcohol Treatment Program450 Seaview AvenueStaten IslandNYActive
DSH330160FChildDSHSTATEN ISLAND UNIVERSITY HOSPITALBay Street Health Center57 Bay StreetStaten IslandNYTerminated
DSH330160GChildDSHSTATEN ISLAND UNIVERSITY HOSPITALStaten Island University Hospital - Alcohol Clinic450 Seaview AvenueStaten IslandNYActive
DSH330160HChildDSHSTATEN ISLAND UNIVERSITY HOSPITALCenter for Women's Health-OBGYN440 Seaview AvenueStaten IslandNYActive
DSH330160JChildDSHSTATEN ISLAND UNIVERSITY HOSPITALAdolescent1133 Forest Hill RoadStaten IslandNYTerminated
DSH330160KChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSchool Health Center at New Dorp465 New Dorp LaneStaten IslandNYActive
DSH330160LChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion-Radiology256 Mason AvenueStaten IslandNYActive
DSH330160MChildDSHSTATEN ISLAND UNIVERSITY HOSPITALPort Richmond School Based Clinic - Adolescent Medicine85 St. Joseph's AvenueStaten IslandNYActive
DSH330160PChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSTATEN ISLAND UNIVERSITY HOSPITAL - Burn500 SEAVIEW AVESTATEN ISLANDNYActive
DSH330160QChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Diabetic Education242 Mason AvenueStaten IslandNYActive
DSH330160RChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth OP - Sleep Services375 Seguine AvenueStaten IslandNYActive
DSH330160SChildDSHSTATEN ISLAND UNIVERSITY HOSPITALDiabetic Treatment - Clinic500 Seaview AvenueStaten IslandNYActive
DSH330160TChildDSHSTATEN ISLAND UNIVERSITY HOSPITALOutpatient Mental Health Clinic - Mental Health450 Seaview AvenueStaten IslandNYActive
DSH330160UChildDSHSTATEN ISLAND UNIVERSITY HOSPITALHigh Risk Antepartum Testing - Clinic440 Seaview AvenueStaten IslandNYActive
DSH330160VChildDSHSTATEN ISLAND UNIVERSITY HOSPITALFemale Pelvic Floor - Clinic440 Seaview AvenueStaten IslandNYActive
DSH330160WChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth OP - Chemical Dependency Treatment Program392 Seguine AvenueStaten IslandNYActive
DSH330160XChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Infectious Disease242 Mason AvenueStaten IslandNYActive
DSH330160YChildDSHSTATEN ISLAND UNIVERSITY HOSPITALMedical Arts Pavilion - Rehab Services242 Mason AvenueStaten IslandNYActive
DSH330160ZChildDSHSTATEN ISLAND UNIVERSITY HOSPITALSouth-Cardiology Services375 Seguine AvenueStaten IslandNYActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberInsertGroup Change Request 114471417110/25/2024 1:34 PM
Medicaid BillingNPI: StateInsertGroup Change Request NY10/25/2024 1:34 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request05431874 (NY) 9/26/2024 1:59 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request04634960 (NY) 9/26/2024 1:59 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request04633703 (NY) 9/26/2024 1:59 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1669854832 (NY) 9/26/2024 1:59 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1730523549 (NY) 9/26/2024 1:59 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1851807929 (NY) 9/26/2024 1:59 PM
DetailsLast Recertification DateUpdateRecertification8/22/2023 1:37:49 PM8/19/2024 2:02:06 PM8/19/2024 2:02 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2023 12:46 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0543187412/14/2023 12:46 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/14/2023 12:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2023 12:46 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0463496012/14/2023 12:46 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/14/2023 12:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2023 12:46 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0463370312/14/2023 12:46 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/14/2023 12:46 PM
Medicaid BillingNPI: NumberInsertChange Request 166985483212/14/2023 12:46 PM
Medicaid BillingNPI: StateInsertChange Request NY12/14/2023 12:46 PM
Medicaid BillingNPI: NumberInsertChange Request 173052354912/14/2023 12:46 PM
Medicaid BillingNPI: StateInsertChange Request NY12/14/2023 12:46 PM
Medicaid BillingNPI: NumberInsertChange Request 185180792912/14/2023 12:46 PM
Medicaid BillingNPI: StateInsertChange Request NY12/14/2023 12:46 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestCusack, Michele L SVP & CFO Northwell Health 5163216058Cusack, Michele L Executive Vice President Northwell Health 51632160589/6/2023 3:19 PM
DetailsLast Recertification DateUpdateRecertification9/6/2022 3:39:17 PM8/22/2023 1:37:49 PM8/22/2023 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1700480050 (NY) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1396755922 (NY) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1912925199 (NY) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1225062193 (NY) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1144714171 (NY) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1700480050 (OH) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1396755922 (OH) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1912925199 (OH) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1225062193 (OH) 11/7/2022 12:50 PM
Medicaid BillingNPI: NumberDeleteChange Request1144714171 (OH) 11/7/2022 12:50 PM
Medicaid BillingMedicaid: NumberDeleteChange Request00244202 (NY) 11/2/2022 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/2/2022 12:29 PM
Medicaid BillingMedicaid: NumberInsertChange Request 00244202 (NY)11/2/2022 12:29 PM
Medicaid BillingMedicaid: StateInsertChange Request NY11/2/2022 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/2/2022 12:29 PM
Medicaid BillingMedicaid: NumberInsertChange Request 05380841 (NY)11/2/2022 12:29 PM
Medicaid BillingMedicaid: StateInsertChange Request NY11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 170048005011/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request NY11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 139675592211/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request NY11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 191292519911/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request NY11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 122506219311/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request NY11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 114471417111/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request NY11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 170048005011/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request OH11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 139675592211/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request OH11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 191292519911/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request OH11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 122506219311/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request OH11/2/2022 12:29 PM
Medicaid BillingNPI: NumberInsertChange Request 114471417111/2/2022 12:29 PM
Medicaid BillingNPI: StateInsertChange Request OH11/2/2022 12:29 PM
AddressesMain AddressUpdateChange Request 242 Mason Avenue Staten Island, NY 10305 242 Mason Avenue 1st floor Staten Island, NY 1030510/6/2022 2:49 PM
DetailsEntity SubnameUpdateChange RequestMedical Arts Pavilion - Physical Therapy - Physical TherapyMedical Arts Pavilion - Rehab Services10/6/2022 2:49 PM
ContactsPrimary ContactUpdateRecertificationPeana, John Director of Pharmacy Staten Island University Hospital 7182268870Stefas, Onisis VP of Pharmacy Operations Northwell 51671957209/6/2022 3:39 PM
DetailsLast Recertification DateUpdateRecertification 9/6/2022 3:39:17 PM9/6/2022 3:39 PM
ContactsAuthorizing OfficialUpdateChange RequestArdolic, Brahim Executive Director Staten Island University Hospital 7182269761Cusack, Michele L SVP & CFO Northwell Health 51632160582/22/2022 4:36 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/21/2022 11:12 AM
Medicaid BillingMedicaid: NumberInsertChange Request 22040821/21/2022 11:12 AM
Medicaid BillingMedicaid: StateInsertChange Request OH1/21/2022 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 14078771371/21/2022 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OH1/21/2022 11:12 AM
DetailsStateUpdate ApprovedActive1/1/2022 12:01 AM
ContactsSigned ByInsertNew Registration Ardolic, Brahim Executive Director Staten Island University Hospital 718226976111/29/2021 6:39 AM
Details340B IDUpdateNew Registration DSH330160Y11/29/2021 6:39 AM
DetailsEntity SubnameUpdateNew RegistrationMedical Arts Pavilion - Physical TherapyMedical Arts Pavilion - Physical Therapy - Physical Therapy11/29/2021 6:39 AM
DatesParticipating Approval DateUpdateNew Registration 11/29/2021 6:39:32 AM11/29/2021 6:39 AM
DetailsStateUpdateNew RegistrationPendingApproved11/29/2021 6:39 AM
DatesSigned By DateUpdateNew Registration 11/23/2021 2:01:18 PM11/29/2021 6:39 AM
DatesStart DateUpdateNew Registration 1/1/2022 12:00:00 AM11/29/2021 6:39 AM
AddressesMain AddressInsertNew Registration  242 Mason Avenue Staten Island, NY 1030510/15/2021 12:57 PM
AddressesBilling AddressInsertNew Registration Staten Island University Hospital 475 Seaview Avenue Staten Island, NY 1030510/15/2021 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/15/2021 12:57 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 0024420210/15/2021 12:57 PM
Medicaid BillingMedicaid: StateInsertNew Registration NY10/15/2021 12:57 PM
Medicaid BillingNPI: NumberInsertNew Registration 140787713710/15/2021 12:57 PM
Medicaid BillingNPI: StateInsertNew Registration NY10/15/2021 12:57 PM
ContactsAuthorizing OfficialInsertNew Registration Ardolic, Brahim Executive Director Staten Island University Hospital 718226976110/15/2021 12:57 PM
ContactsPrimary ContactInsertNew Registration Peana, John Director of Pharmacy Staten Island University Hospital 718226887010/15/2021 12:57 PM
DetailsAssistance Received From DateInsertNew Registration  10/15/2021 12:57 PM
DetailsAssistance Received To DateInsertNew Registration  10/15/2021 12:57 PM
DetailsLast Recertification DateInsertNew Registration  10/15/2021 12:57 PM
DetailsGrant NumberInsertNew Registration  10/15/2021 12:57 PM
Details340B IDInsertNew Registration  10/15/2021 12:57 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/15/2021 12:57 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/15/2021 12:57 PM
DetailsMedicare Provider NumberInsertNew Registration 33016010/15/2021 12:57 PM
DetailsEntity NameInsertNew Registration STATEN ISLAND UNIVERSITY HOSPITAL10/15/2021 12:57 PM
DetailsNOFO NumberInsertNew Registration  10/15/2021 12:57 PM
DetailsProgram CodeInsertNew Registration DSH10/15/2021 12:57 PM
DetailsEntity SubnameInsertNew Registration Medical Arts Pavilion - Physical Therapy10/15/2021 12:57 PM
DatesParticipating Approval DateInsertNew Registration  10/15/2021 12:57 PM
DetailsStateInsertNew Registration Pending10/15/2021 12:57 PM
DatesRegistration DateInsertNew Registration 10/15/2021 12:57:37 PM10/15/2021 12:57 PM
DatesSigned By DateInsertNew Registration  10/15/2021 12:57 PM
DatesStart DateInsertNew Registration  10/15/2021 12:57 PM
TerminationsTermination CommentsInsertNew Registration  10/15/2021 12:57 PM
TerminationsTermination DateInsertNew Registration  10/15/2021 12:57 PM
TerminationsTermination Effective DateInsertNew Registration  10/15/2021 12:57 PM
TerminationsTermination ReasonInsertNew Registration  10/15/2021 12:57 PM