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DSH330232 SETON HEALTH SYSTEM (Terminated)
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Main Details
Name
SETON HEALTH SYSTEM
Subdivision Name
St. Mary's Hospital
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330232
Medicare Provider Number
330232
Additional Details
Current Program Status
Terminated
Registration Date
5/30/2006
Participating Start Date
10/1/2009
Participating Approval Date
9/4/2009
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
4/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537
Primary Contact
Samaritan Hospital of Troy NY
JEANNE KENNICUTT, MGR AMBULATORY CARE PHARMACY SERVICES
(518) 525-6132
Addresses
Street Address
1300 MASSACHUSETTS AVE
TROY, NY 12180
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/1/09 REINSTATED ORIG PART FROM 7/1/2006 TO 9/30/2007, NOT ELIG FROM 10/1/2007 TO 9/30/2009 AND REMOVED MEDICAID PROVIDER NUMBER (WAS 01534463)
09/04/2009
April 2025
April 2025
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