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DSH330208B ST JOHNS RIVERSIDE HOSPITAL (Active)
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Main Details
Name
ST JOHNS RIVERSIDE HOSPITAL
Subdivision Name
ARCHWAY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330208B
Medicare Provider Number
330208
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/29/2019
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
St. John's Riverside Hospital
Michael A DiGiorno, Chief Operating Officer
(914) 798-8972
Primary Contact
St John's Riverside Hospital
JANINE O'DONNELL, AVP of Pharmacy and Medical Operations
(914) 964-4827
Addresses
Street Address
20 EAST 1ST STREET
MT VERNON, NY 10550
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start date 7/1/2004, Termination 10/1/2015, Reinstate 10/1/2019
07/16/2019
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