Covered Entity Details

DSH330211J CLAXTON HEPBURN MEDICAL CENTER (Terminated) - information as of 6/28/2025 12:21:08 AM

Main Details

Name

CLAXTON HEPBURN MEDICAL CENTER

Subdivision Name

Claxton Hepburn Cancer Treatment Center - Oncology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330211J

Medicare Provider Number

330211

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/28/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/31/2022

Last Recertification Date

8/20/2024

Termination Date
Termination Reason

1/1/2025
Business decision by the Covered Entity

Contacts

Authorizing Official

Claxton-Hepburn Medical Center
Richard Duvall, CEO
(315) 713-5237

Primary Contact

Claxton Hepburn Medical Center
Danny Sekhon, Director of Pharmacy
(315) 713-5685

Addresses

Street Address

214 King Street
Ogdensburg, NY 13669

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	02997831	1891753034

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
DSH330211A	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	Claxton Hepburn Health Center	100 Horwood Place	Ogdensburg	NY	Terminated
DSH330211B	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	HAMMOND HEALTH CENTER	225 ST LAWRENCE AVENUE	HAMMOND	NY	Terminated
DSH330211D	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	Heuvelton Health Center	214 King Street	Ogdensburg	NY	Terminated
DSH330211E	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	CANTON HEALTH CENTER	39 WEST MAIN STREET	CANTON	NY	Terminated
DSH330211F	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	MADRID HEALTH CENTER	2263 State Highway 310	MADRID	NY	Terminated
DSH330211G	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	WADDINGTON HEALTH CENTER	4 MONTGOMERY HEIGHTS	WADDINGTON	NY	Terminated
DSH330211H	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	Lisbon Health Center - Primary Care	214 King Street	Ogdensburg	NY	Terminated
DSH330211J	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	Claxton Hepburn Cancer Treatment Center - Oncology	214 King Street	Ogdensburg	NY	Terminated
DSH330211K	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	CHMC-Ravinder Agarwal Renal Center - Dialysis	214 King Street	Ogdensburg	NY	Terminated
DSH330211L	Child	DSH	CLAXTON HEPBURN MEDICAL CENTER	Claxton Hepburn Outpatient Services - Mental Health Services and ancillary departments	214 King Street	Ogdensburg	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2024 12:00:00 AM	10/29/2024 12:58 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/29/2024 12:58 PM
Terminations	Termination Comments	Update	Termination Request		Change in ownership and new CMS designation	10/29/2024 12:58 PM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	10/29/2024 12:58 PM
Terminations	Termination Effective Date	Update	Termination Request		10/23/2024 12:00:00 AM	10/29/2024 12:58 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	10/29/2024 12:58 PM
Addresses	Main Address	Update	Group Change Request	5 Lyons Place Ogdensburg, NY 13669	214 King Street Ogdensburg, NY 13669	9/10/2024 6:08 AM
Details	Last Recertification Date	Update	Recertification	8/24/2023 10:20:10 AM	8/20/2024 12:48:06 PM	8/20/2024 12:48 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 1:38:16 PM	8/24/2023 10:20:10 AM	8/24/2023 10:20 AM
Contacts	Primary Contact	Update	PC Change Request	Burch, Eric 340B Coordinator Claxton-Hepburn Medical Center 3157135235	Sekhon, Danny Director of Pharmacy Claxton Hepburn Medical Center 3157135685	6/20/2023 7:28 AM
Details	Last Recertification Date	Update	Recertification		8/31/2022 1:38:16 PM	8/31/2022 1:38 PM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Duvall, Richard CEO Claxton-Hepburn Medical Center 3157135237	1/31/2022 8:40 AM
Details	340B ID	Update	New Registration		DSH330211J	1/31/2022 8:40 AM
Details	Entity Subname	Update	New Registration	Claxton Hepburn Cancer Treatment Center	Claxton Hepburn Cancer Treatment Center - Oncology	1/31/2022 8:40 AM
Dates	Participating Approval Date	Update	New Registration		1/31/2022 8:40:04 AM	1/31/2022 8:40 AM
Details	State	Update	New Registration	Pending	Approved	1/31/2022 8:40 AM
Dates	Signed By Date	Update	New Registration		1/28/2022 5:41:11 PM	1/31/2022 8:40 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/31/2022 8:40 AM
Addresses	Main Address	Insert	New Registration		5 Lyons Place Ogdensburg, NY 13669	1/28/2022 3:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/28/2022 3:17 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		02997831	1/28/2022 3:17 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/28/2022 3:17 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1891753034	1/28/2022 3:17 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	1/28/2022 3:17 PM
Contacts	Authorizing Official	Insert	New Registration		Duvall, Richard CEO Claxton-Hepburn Medical Center 3157135237	1/28/2022 3:17 PM
Contacts	Primary Contact	Insert	New Registration		Burch, Eric 340B Coordinator Claxton-Hepburn Medical Center 3157135235	1/28/2022 3:17 PM
Details	Assistance Received From Date	Insert	New Registration			1/28/2022 3:17 PM
Details	Assistance Received To Date	Insert	New Registration			1/28/2022 3:17 PM
Details	Last Recertification Date	Insert	New Registration			1/28/2022 3:17 PM
Details	Grant Number	Insert	New Registration			1/28/2022 3:17 PM
Details	340B ID	Insert	New Registration			1/28/2022 3:17 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/28/2022 3:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/28/2022 3:17 PM
Details	Medicare Provider Number	Insert	New Registration		330211	1/28/2022 3:17 PM
Details	Entity Name	Insert	New Registration		CLAXTON HEPBURN MEDICAL CENTER	1/28/2022 3:17 PM
Details	NOFO Number	Insert	New Registration			1/28/2022 3:17 PM
Details	Program Code	Insert	New Registration		DSH	1/28/2022 3:17 PM
Details	Entity Subname	Insert	New Registration		Claxton Hepburn Cancer Treatment Center	1/28/2022 3:17 PM
Dates	Participating Approval Date	Insert	New Registration			1/28/2022 3:17 PM
Details	State	Insert	New Registration		Pending	1/28/2022 3:17 PM
Dates	Registration Date	Insert	New Registration		1/28/2022 3:17:55 PM	1/28/2022 3:17 PM
Dates	Signed By Date	Insert	New Registration			1/28/2022 3:17 PM
Dates	Start Date	Insert	New Registration			1/28/2022 3:17 PM
Terminations	Termination Comments	Insert	New Registration			1/28/2022 3:17 PM
Terminations	Termination Date	Insert	New Registration			1/28/2022 3:17 PM
Terminations	Termination Effective Date	Insert	New Registration			1/28/2022 3:17 PM
Terminations	Termination Reason	Insert	New Registration			1/28/2022 3:17 PM