340B Drug Pricing Program Database
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DSH330241DB UNIVERSITY HOSPITAL (Active)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
UROLOGY CLINIC AT VERONA- PROVIDER BASED - Urology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330241DB
Medicare Provider Number
330241
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/1/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/23/2024
Last Recertification Date
Contacts
Authorizing Official
SUNY Upstate Medical University Hospital
Stuart M. Wright, Chief Financial Officer
(315) 464-5179
Primary Contact
SUNY Upstate Medical University Hospital
Amanda Marzella, 340B Contract Pharmacy Manager
(315) 464-6039
Addresses
Street Address
Upstate Cancer Center at Verona
5584 East Main Street
Verona, NY 13478
Billing Address
Upstate University Hospital
750 East Adams Street
Syracuse, NY 13210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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