340B Drug Pricing Program Database
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DSH330047AU ST. MARYS HEALTHCARE (Approved)
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Main Details
Name
ST. MARYS HEALTHCARE
Subdivision Name
General Surgery Office - General Surgery Office
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330047AU
Medicare Provider Number
330047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/4/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/30/2025
Last Recertification Date
Contacts
Authorizing Official
St. Mary's Healthcare
Keith Waters, Vice President of Finance/CFO
(518) 770-7583
Primary Contact
St. Mary's Healthcare
Tami Wessel, 340B Program Lead
(518) 256-1163
Addresses
Street Address
425 Guy Park Ave
Amsterdam, NY 12010
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
May 2025
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