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DSH330057Q ST. PETERS HOSPITAL (Active)
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Main Details
Name
ST. PETERS HOSPITAL
Subdivision Name
ST PETERS HOSPITAL OF THE CITY OF A - Neurosurgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330057Q
Medicare Provider Number
330057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/31/2024
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537
Primary Contact
Saint Peters Hospital Albany NY
John Joseph Faccone, Trinity NY Regional 340B Manager
(518) 326-7510
Addresses
Street Address
1182 TROY SCHENECTADY RD
STE 100
LATHAM, NY 12110-1000
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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